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首页> 外文期刊>Life sciences >Is basic research providing answers if adjuvant anti-estrogen treatment of breast cancer can induce cognitive impairment?
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Is basic research providing answers if adjuvant anti-estrogen treatment of breast cancer can induce cognitive impairment?

机译：乳腺癌的辅助抗雌激素治疗能否诱发认知障碍，基础研究是否提供答案？

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Adjuvant treatment of cancer by chemotherapy is associated with cognitive impairment in some cancer survivors. Breast cancer patients are frequently also receiving endocrine therapy with selective estrogen receptor modulators (SERMs) and/or aromatase inhibitors (AIs) to suppress the growth of estradiol sensitive breast tumors. Estrogens are well-known, however, to target brain areas involved in the regulation of cognitive behavior. In this review clinical and basic preclinical research is reviewed on the actions of estradiol, SERMs and AIs on brain and cognitive functioning to see if endocrine therapy potentially induces cognitive impairment and in that respect may contribute to the detrimental effects of chemotherapy on cognitive performance in breast cancer patients. Although many clinical studies may be underpowered to detect changes in cognitive function, current basic and clinical reports suggest that there is little evidence that AIs may have a lasting detrimental effect on cognitive performance in breast cancer patients. The clinical data on SERMs are not conclusive, but some studies do suggest that tamoxifen administration may form a risk for cognitive functioning particularly in older women. An explanation may come from basic preclinical research which indicates that tamoxifen often acts agonistic in the absence of estradiol but antagonistic in the presence of endogenous estradiol. It could be hypothesized that the negative effects of tamoxifen in older women is related to the so-called window of opportunity for estrogen. Administration of SERMs beyond this so-called window of opportunity may not be effective or might even have detrimental effects similar to estradiol.
机译：在某些癌症幸存者中，化学疗法对癌症的辅助治疗与认知障碍有关。乳腺癌患者经常还接受选择性雌激素受体调节剂（SERM）和/或芳香酶抑制剂（AIs）的内分泌治疗，以抑制雌二醇敏感性乳腺肿瘤的生长。然而，众所周知，雌激素靶向调节认知行为的大脑区域。在这篇综述中，对雌二醇，SERM和AI对大脑和认知功能的作用进行了临床和基础临床前研究的综述，以了解内分泌治疗是否可能诱发认知障碍，并且在这方面可能会导致化学疗法对乳腺癌认知功能的有害影响癌症患者。尽管许多临床研究可能不足以检测认知功能的变化，但是当前的基础和临床报告表明，几乎没有证据表明AI可能对乳腺癌患者的认知表现产生持久的不利影响。关于SERM的临床数据尚无定论，但一些研究确实表明，他莫昔芬的使用可能会形成认知功能的风险，尤其是在老年妇女中。有可能来自基础临床前研究的解释，该研究表明他莫昔芬通常在没有雌二醇的情况下起激动作用，而在内源性雌二醇的存在下起拮抗作用。可以假设他莫昔芬对老年妇女的不良影响与所谓的雌激素机会窗有关。在所谓的机会之窗之外进行SERM的管理可能无效，甚至可能产生类似于雌二醇的有害作用。

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