Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial.

Abstract

PURPOSE:

To report the neurocognitive findings in a phase III randomized trial evaluating survival and neurologic and neurocognitive function in patients with brain metastases from solid tumors receiving whole-brain radiation therapy (WBRT) with or without motexafin gadolinium (MGd).

PATIENTS AND METHODS:

Patients were randomly assigned to receive WBRT 30 Gy in 10 fractions with or without MGd 5 mg/kg/d. Monthly neurocognitive testing for memory, executive function, and fine motor skill was performed.

RESULTS:

Four hundred one patients were enrolled (251 with non-small-cell lung cancer, 75 with breast cancer, and 75 with other cancers); 90.5% patients had impairment of one or more neurocognitive tests at baseline. Neurocognitive test scores of memory, fine motor speed, executive function, and global neurocognitive impairment at baseline were correlated with brain tumor volume and predictive of survival. There was no statistically significant difference between treatment arms in time to neurocognitive progression. Patients with lung cancer (but not other types of cancer) who were treated with MGd tended to have improved memory and executive function (P =.062) and improved neurologic function as assessed by a blinded events review committee (P =.048).

CONCLUSION:

Neurocognitive tests are a relatively sensitive measure of brain functioning; a combination of tumor prognostic variables and brain function assessments seems to predict survival better than tumor variables alone. Although the addition of MGd to WBRT did not produce a significant overall improvement between treatment arms, MGd may improve memory and executive function and prolong time to neurocognitive and neurologic progression in patients with brain metastases from lung cancer.

• Authors: Christina A Meyers, Jennifer A Smith, Andrea Bezjak, Minesh P Mehta, James Liebmann, Tim Illidge, Ian Kunkler, Jean-Michel Caudrelier, Peter D Eisenberg, Jacobus Meerwaldt, Ross Siemers, Christian Carrie, Laurie E Gaspar, Walter Curran, See-Chun Phan, Richard A Miller, Markus F Renschler
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 22 Issue 1 Pg. 157-65 (Jan 01 2004) ISSN: 0732-183X [Print] United States
• PMID: 14701778 (Publication Type: Clinical Trial, Clinical Trial, Phase III, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents
• Metalloporphyrins
• motexafin gadolinium

Topics

• Adult
• Aged
• Antineoplastic Agents (administration & dosage, therapeutic use)
• Brain Neoplasms (radiotherapy, secondary)
• Breast Neoplasms (pathology)
• Cognition Disorders (etiology)
• Cranial Irradiation (adverse effects)
• Disease Progression
• Female
• Humans
• Lung Neoplasms (pathology)
• Male
• Memory Disorders (etiology)
• Metalloporphyrins (administration & dosage, therapeutic use)
• Middle Aged
• Motor Skills
• Psychometrics
• Survival Analysis
• Treatment Outcome