Donepezil for Irradiated Brain Tumor Survivors: A Phase III Randomized Placebo-Controlled Clinical Trial

被引:155
作者
Rapp, Stephen R. [1 ,2 ]
Case, L. Doug [1 ,2 ]
Peiffer, Ann [1 ,2 ]
Naughton, Michelle M. [1 ,2 ]
Chan, Michael D. [1 ,2 ]
Stieber, Volker W. [3 ]
Moore, Dennis F., Jr. [4 ]
Falchuk, Steven C. [5 ]
Piephoff, James V. [6 ]
Edenfield, William J. [7 ]
Giguere, Jeffrey K. [7 ]
Loghin, Monica E. [8 ]
Shaw, Edward G. [1 ,2 ]
机构
[1] Wake Forest Univ, Bowman Gray Sch Med, Winston Salem, NC 27157 USA
[2] Wake Forest Community Clin Oncol Program Res Base, Winston Salem, NC USA
[3] Novant Hlth Syst, Winston Salem, NC USA
[4] Wichita Community Clin Oncol Program, Wichita, KS USA
[5] Christiana Care Hlth Syst, Newark, DE USA
[6] Mercy Hosp, St Louis, MO USA
[7] Canc Ctr Carolinas, Greenville, SC USA
[8] Univ Texas MD Anderson Canc Ctr, Houston, TX 77030 USA
基金
美国国家卫生研究院;
关键词
CANCER-TREATMENT; MEMANTINE; MODERATE; MEMORY; RADIOTHERAPY; DISEASE; UPDATE;
D O I
10.1200/JCO.2014.58.4508
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose Neurotoxic effects of brain irradiation include cognitive impairment in 50% to 90% of patients. Prior studies have suggested that donepezil, a neurotransmitter modulator, may improve cognitive function. Patients and Methods A total of 198 adult brain tumor survivors >= 6 months after partial- or whole-brain irradiation were randomly assigned to receive a single daily dose (5 mg for 6 weeks, 10 mg for 18 weeks) of donepezil or placebo. A cognitive test battery assessing memory, attention, language, visuomotor, verbal fluency, and executive functions was administered before random assignment and at 12 and 24 weeks. A cognitive composite score (primary outcome) and individual cognitive domains were evaluated. Results Of this mostly middle-age, married, non-Hispanic white sample, 66% had primary brain tumors, 27% had brain metastases, and 8% underwent prophylactic cranial irradiation. After 24 weeks of treatment, the composite scores did not differ significantly between groups (P = .48); however, significant differences favoring donepezil were observed for memory (recognition, P = .027; discrimination, P = .007) and motor speed and dexterity (P = .016). Significant interactions between pretreatment cognitive function and treatment were found for cognitive composite (P = .01), immediate recall (P = .05), delayed recall (P = .004), attention (P = .01), visuomotor skills (P = .02), and motor speed and dexterity (P < .001), with the benefits of donepezil greater for those who were more cognitively impaired before study treatment. Conclusion Treatment with donepezil did not significantly improve the overall composite score, but it did result in modest improvements in several cognitive functions, especially among patients with greater pretreatment impairments. (C) 2015 by American Society of Clinical Oncology
引用
收藏
页码:1653 / +
页数:10
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