Cancer-related Cognitive Impairment, Cognitive Impairment, Depression, Anxiety, Fatigue, Inflammation, Melanoma, Quality of Life, Sickness Behavior, Sleep
Conditions
Keywords
Immune Checkpoint Inhibitors, Melanoma, Cancer-related Symptoms, Cognitive Dysfunction
Brief summary
Immune checkpoint inhibitors (ICIs) are a group of novel immunotherapies that boost the body's own defense against the cancer by improving the immune system's ability to recognize and destroy cancer cells. While it is relatively well-documented that conventional cancer treatments (e.g., chemotherapy) are associated with cognitive impairment, virtually nothing is yet known about effects on cognition during and after ICI treatment. Due to significantly improved survival rates after ICI treatments, it becomes important to map possible adverse effects associated with these treatments. The investigators therefore investigate possible changes in cognitive function in a group of cancer patients from prior to ICI treatment to nine months later. A gender- and age- matched healthy control group will serve as a comparison. The study has the potential to broaden our understanding of associations between cognition, the brain, and the immune system and to provide clinically relevant knowledge about possible cognitive impairments associated with immunotherapy.
Detailed description
This controlled prospective observational study will include two groups with a total of 84 participants. A total of 42 patients diagnosed with melanoma, referred to treatment with ICI will be enrolled in the study and examined prior to treatment with ICI (baseline), at eight weeks following baseline (T2), at 24 weeks following baseline (T3) and 12 weeks after treatment completed (T4). A total of 42 gender- and age- matched healthy controls will be included and assessed at similar time points. Assessments will include a battery of neuropsychological tests, questionnaires, blood samples, and Magnetic Resonance Imaging (MRI). The main objectives of the study are to investigate: 1. Changes in cognitive functions over the course of treatment with ICIs. 2. Possible associations between changes in cognitive function and immune markers during and following ICI treatment. 3. Possible associations between changes in cognitive function and changes in brain morphology. 4. Changes over time in other possible adverse effects of ICI treatment, including psychological distress, sleep disturbances, and fatigue.
Interventions
None listed
Sponsors
University of Aarhus
Aarhus University Hospital
Study design
Observational model
CASE_CONTROL
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Confirmed diagnosis of melanoma and scheduled for ICI treatment at Aarhus University Hospital (AUH), Denmark. The healthy control group will consist of an age- and gender- matched sample of participants.
Exclusion criteria
* Previous treatment with immunotherapy * Neurodegenerative diseases (dementia etc.) * Substance abuse * Known progressive psychiatric diseases (e.g., Schizophrenia) * Other confirmed diagnoses with underlying cognitive impairment * Insufficient Danish proficiency
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Attention | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in attention as measured with WAIS-IV The Digit Span Forwards (scores with a minimum of 0 points to a maximum of 16 points - higher scores mean a better outcome) |
| Processing Speed | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in processing speed as measured with WAIS-IV The Digit Symbol coding (scores ranging from a minimum of 0 and a maximum of 135 with higher scores indicating a better outcome) |
| Working memory | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in working memory as measured with WAIS-IV The Digit Span Backwards (scores with a minimum of 0 points to a maximum of 16 points - higher scores mean a better outcome) |
| Learning and memory | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in learning and memory as measured with the Hopkins Verbal Learning Test - Revised (part 1 include a minimum score of 0 and a maximum score of 36 with higher score indicating a better outcome, part 2 include a minimum score of 0 and a maximum score of 12 with higher scores indicating better outcomes) |
| Visuospatial ability | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in visuospatial ability as measured with WAIS-IV Matrix Reasoning (scores with a minimum of 0 and a maximum of 26 with higher scores indicating better outcomes) |
| Verbal fluency | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in verbal fluency as measured with the Controlled Oral Word Association Test, letter and animal (as many words as possible, more words indicating a better outcome. No maximum value) |
| Executive function | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in executive function as measured with the Trail Making Test B (outcome is time in seconds) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Inflammatory immune markers | Baseline, and week 8, 24 and 12 weeks after completed treatment | TNF-α, IL-6, IL-8, IL-21, CRP, IP-10 and MCP-1 extracted from blood samples |
| Cancer-related fatigue | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in fatigue severity as measured with The Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT fatigue) scale (range from 0 to 52. Items are reverse scored when appropriate to provide a scale in which higher scores represent better functioning or less fatigue) |
| Brain white matter | Baseline and week 24. | Changes in brain white matter as measured with T1-weighted MRI |
| Brain grey matter | Baseline and week 24. | Changes in brain grey matter as measured with T1-weighted MRI |
| Sleep quality | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in sleep quality as measured with the Insomnia Severity Index (ISI) (scores ranging from a minimum of 0 and a maximum of 28 with higher scores indicating higher levels of insomnia) |
| Perceived cognitive functioning | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in perceived cognitive functioning as measured with The Patient Assessment of Own Functioning Inventory (PAOFI) (outcome is scores ranging from a minimum of 35 to a maximum of 210) |
| Depression/Anxiety | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in depression/anxiety as measured with the Hospital Anxiety and Depression Scale (HADS) (range from a minimum score of 0 to a maximum score of 21 in which a higher scores mean higher levels of depression/anxiety) |
| Sickness behavior | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in subjective sickness behavior as measured with the Sickness Questionnaire (SicknessQ) (scores ranging from a minimum of 0 and a maximum of 30 with higher scores indicating worse outcome) |
| Health-related quality of life | Baseline, and week 8, 24 and 12 weeks after completed treatment | Changes in health-related quality of life as measured with The European Organization for Research and Treatment of Cancer, Quality of Life questionnaire for cancer patients (EORTC QLQ-C30) (all of the scales and single-item measures range in score from 0 to 100. A high scale score represents a higher response level.) |
| Moderator: genotype | Baseline | Genotype of COMT and APOE4 Genotype of COMT |
Countries
Denmark
Outcome results
None listed