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INTERNATIONAL CONGRESS OF

CancerGenetics

• Investigation of the Relationship Between Neurocognitive Function Following Chemotherapy and Anti-Angiogenic Agents Combined with Chemotherapy and Radiotherapy for Nasopharyngeal Carcinoma

• Sepideh Hadj Foroosh,¹ Ali Ahmadi,^2,*
  1. MD, The Ear, Nose, and Throat (ENT) clinic of Dr. Hadj Foroosh, Sari, Iran
  2. M.Sc. Student of Genetics, Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
  
  
  
• Introduction: Cancer is a complex disease and the second leading cause of death in the United States. According to the American Cancer Society (ACS) report in 2020, more than 1.8 million new cancer cases are expected to be identified in this country, and approximately 606,520 individuals are anticipated to lose their lives due to this disease. In recent decades, new cancer drugs designed as small molecules have demonstrated greater efficacy compared to older drugs. Nasopharyngeal carcinoma (NPC) is a cancer associated with Epstein-Barr virus (EBV) and is prevalent in southern China, Southeast Asia, and North Africa. Biomarkers related to the progression and metastasis of nasopharyngeal carcinoma (NPC) enable researchers to better understand the disease. These biomarkers can be divided into two groups: predictive markers that allow for the assessment of the risk of clinical outcomes such as recurrence, metastasis, and disease progression; and diagnostic markers that identify whether an individual has a specific disease. Thus, biomarkers can enhance early detection and predictive methods. Definitive radiotherapy (RT), with or without chemotherapy, is recognized as the standard treatment for patients with head and neck cancers (HNC). Epidemiological changes, diagnostic advancements, and novel therapeutic approaches have led to increased life expectancy. Given the greater focus on survival, achieving a balance between tumor control and toxicity prevention has become a key challenge. Neurocognitive impairments can be one of the side effects of common cancer treatments, including radiotherapy when doses are delivered to brain tissue and chemotherapy. Neurocognitive function is a performance outcome, and even minor impairments can negatively impact quality of life (QOL) and daily functioning. The aim of this study is to determine the relationship between neurocognitive function following chemotherapy with anti-angiogenic agents combined with chemotherapy and radiotherapy for nasopharyngeal carcinoma.
• Methods: This research serves as a narrative review study of secondary studies aimed at gathering and presenting information regarding the relationship between neurocognitive function following chemotherapy and anti-angiogenic agents in conjunction with nasopharyngeal carcinoma. The articles reviewed in this context have been published up to 2024. This study was conducted by searching for keywords such as Neurocognitive Function, Chemotherapy, Anti-Angiogenic Agents, Radiotherapy, and Nasopharyngeal Carcinoma in reputable databases such as Science Direct, Scopus, PubMed, and Web of Science.
• Results: In the past three decades, there have been significant advancements in understanding the molecular biology and treatment of nasopharyngeal carcinoma (NPC). Biomarkers are key to preventing the progression, recurrence, and metastasis of NPC, and they are also essential for the development of effective therapies. With the aid of high-throughput "omics" technologies, knowledge regarding the etiology, tumorigenesis, and progression of NPC has progressed rapidly, enabling researchers to identify potential molecular biomarkers. Various types of potential molecular biomarkers for NPC have been identified, including DNA (genomic), mRNA (transcriptomic), protein (proteomic), and metabolite (metabolomic) markers. When radiotherapy is employed in the treatment of head and neck cancers, the brain typically receives incidental doses of radiation that can lead to neurocognitive changes and subsequent effects on quality of life. This issue has not been extensively investigated to date. Most studies have shown that neurocognitive outcomes are inferior compared to control groups at 12 months and beyond following radiotherapy. The neurocognitive domains most affected include memory and language, which appear to be associated with radiation doses received by the hippocampus, temporal lobe, and cerebellum. Magnetic Resonance Imaging (MRI) may be valuable in detecting early microstructural and functional changes that could indicate future neurocognitive alterations. In studies assessing quality of life, the presence of neurocognitive impairments was linked to poorer quality of life outcomes. (Chemo)radiotherapy for head and neck cancer seems to be associated with a risk of long-term neurocognitive impairment. However, only a limited number of studies have been identified, and there exists considerable variability in methodology, which restricts the ability to draw definitive conclusions. There is a need for large-scale, high-quality prospective studies on head and neck cancer that utilize standardized, sensitive, and reliable neurocognitive tests.
• Conclusion: The use of anti-angiogenesis agents alongside chemoradiotherapy, compared to chemoradiotherapy alone, can provide greater benefits in terms of short-term efficacy. This combination is particularly effective in improving both the complete response rate and the objective response rate, while the overall adverse effects remain acceptable.
• Keywords: Neurocognitive Function, Chemotherapy, Anti-Angiogenic Agents, Radiotherapy, and Nasopharyngeal Carc