2 SÉMINAIRE INTERCANCÉROPÔLES – INCA ÈME

2ÈME SÉMINAIRE
INTERCANCÉROPÔLES – INCA
Lille – 18 juin 2013
Impact of cancer and treatments
on cognitive
i i ffunctions
i
2ndd National cancer plan (2009-2013)
Research and innovation,, observation,,
Prevention and screening ,Care, Life
during and after cancer
Research axis of the North West Canceropole
5 axis
 Development
D
l
t and
d validation
lid ti prognostic
ti
and predictive biomarkers to therapeutic innovation
 Tumor onset and progression in malignant blood
disorders
 Multimodality targeting in Oncology
 Cancer and neurosciences (Cognition)
 Cancer,
Cancer individuals and society
 Cancer and neurosciences: Development of integrated
multidisciplinary research program of emerging topics :
C
Cognition
iti and
d cancer
Cancer et cognition
g
Task-Forces
 Cancéropôle symposiums
 CNO symposium Trouville 2008 & 2010
International workshops (ICCTF)
2003 : Benff (Canada), 2005 : Venice (Italy)
2008 : Amsterdam (Netherlands)
Congress/Conferences (ICCTF)
2010: New York (USA)
(USA), 2012 : Paris (France)
ICCTF : International Cancer and Cognition Task-Force
2 ème Sympo Inter-Cancéropôles INCA 2013
 7 Canceropoles
110 participants
ti i
t
Is cancer and cognition a real problem nowadays?
For the patients : definitely yes
• 551 French Patients
• 41% complain of cognitive disorders
with chemo
• 72% consider it a major side effect
Hurricane Voice Breast Cancer
Survey (2007)
 More than 2/3rds complain of cognitive
di d
disorders

Survey, Lefel at al, Bull Cancer 2013
Fatigue (62%)
Treatment (45%)
Anxiety, stress
26%
Memory dysfonction
during and after CT
98%
Negative impact on day to
day lives
62%
Is cancer and cognition a real problem, nowadays?
For the research scientific community
180
160
140
120
100
80
60
40
20
0
num
publications
20022007
20082009
20102012
Pubmed : 302 Abstracts selected on words “cognition
and cancer”
cancer in title and abstract between 2002-2012
definitely yes
Is cancer and cognition a real problem, nowadays ?
For medical
F
di l oncologists
l i t
Yes, but until now, not definitely yes
Wh ?
Why?
 Some doubts on the reality of “chemobrain”
 They don’t have clear explanations on the mechanisms
and which drugs may be involved
 Neuropsychological
N
h l i l ttests
t are diffi
difficult
lt tto organize
i iin routine
ti
 They have no solution to prevent and/or treat cognitive
decline of their patients or to help them to cope with
What we already know
 Chemofog is a reality for breast cancer patients
 But not for all patients
 Incidence : 30% (20 to 70)
 Moderate or subtle troubles (in most cases)
 Main domains impaired
Memory, concentration, information processing speed
and executive functions
 Relationship between objective and subjective
disorders???
 Chemotherapy
Ch
th
agents
t iimplicated
li t d : MTX,
MTX 5FU and
d
Alkylating agents
What we do not know (1)
Impact of the cancer itself on cognitive function?
 CancerBrain or CancerFog
What are the main biological and physiopathological mechanisms involved?
 Imaging and animal models
Breast cancer
 Which groups of patients are at risk?
 Do cognitive disorders improve over time?
What about patients with other cancers?
Impact of other chemotherapy agents or new
targeted therapies?
What we do not know (2)
 How to integrate all the different factors implicated?
(age, co- morbidities, other medications……)
 How to develop specific assessments of disorders in
cancer patients
p
 Specific battery of Neuropsychological tests
 Subjec
Subjective
e app
approaches
oac es (QO
(QOL,, Metacognition,
e acog o , …))
How to simply integrate cognitive evaluation in
routine practice?
How to treat the cognitive problems and how to help
patients to cope with them?
Developments at the Inter-Canceropole Symposium
in Lille?
 Improvement of the network of the French researchers
on cognition and cancer
Multidisciplinary approach
 Bench to bed
 Bed to bench
Animal Approach
Imaging Approach
Clinical Approach
COGNITIVE FUNCTION
AND CANCER
A
Clinical research
Longitudinal and
randomized studies
C
Experience of family
and friends
Longitudinal Studies
West North Canceropole (since 2008)
B
Memory
y impairment
p
Functional Imaging
D
Physiopathology
Ph
i
th l
Behavioural animal
model
T i : Age,
Topics
A
Chemotherapy,
Ch
th
targeted
t
t d therapies,
th
i
compliance
li
to
t orall treatment
t
t
t
Cognitive rehabilitation
1
A
MULTIDISCIPLINARY TEAM
Clinical axis
Manager : Pr Florence Joly
‐Caen : CHU and CLCC François Baclesse
‐ Lille : Lill CLCC Oscar Lambret
CLCC O
L b t
‐ Rouen : CHU and CLCC Henri Becquerel
‐ Bruxelles : Institut Jules Bordet, Nice : CLCC
‐Strasbourg : St b
C
CHU, CLCC
C CC
‐Paris : Institut Gustave Roussy and Hôpital Pitié‐Salpétrière
Neuropsychology / neuroimaging axis
Manager : Dr Bénédicte Giffard ‐Caen : INSERM‐EPHE‐Université de Caen U923 ‐Bruxelles : Institut Jules Bordet
‐Rouen
Rouen : : UPRES PSY.CO
UPRES PSY CO‐ EA 1780
EA 1780
Sociological axis
- Caen : INSERM ERI 13
- Lille : UPRES URECA- EA 1059
Biology axis
Manager : Dr Hélène Castel - Rouen : INSERM U982 and COBRA- UMR 6014
- Caen : CI-NAPS-UMR 6232 and BioTICLA- EA 1772 GRECAN
Example of multidisciplinary program
A
*
Clinical Research
- Cognitive
function
- Fatigue
- Quality of life
Oncology teams
Oncogeriatric teams Longitudinal studies
COG AGE : Elderly Patients treated with adjuvant chemotherapy
COG‐AGE
Eld l P ti t t t d ith dj
t h
th
for breast cancer
B
Neuropsychological
Evaluations and
imaging
C
Animal models
* Oral communication ASCO 20131
Cognition Studies - CNO
Imaging studies
Clinical studies
CANMEM : Neuropsychological
 COG-AGE : Impact of adjuvant
chemo in elderly patients

COG-ANGIO : Impact of targeted
therapies in metastatic kidney
cancer
assessment and fonctionnal MRI
of elderly patients with adjuvant
chemo
h
Animal Models
Chemotherapy and age
COG OBS: Oral
COG-OBS
O l therapy
th
compliance
li
 according to Cognitive functions
 5FU,
5FU O
Oxaliplatine
li l ti
Targeted therapies
 Metacog: Exploration of relations
 Inh MTor/Bevacizumab/Inh of PI3K
between subj&obj cognitive troubles

COG REDUC : Impact
COG-REDUC
I
t off memory
rehabilitation on patients with cognitive
dysfunctions
COG-CANTO: Neuropsychological
 Assessment of pts with breast cancer
What are the next steps ?
Complexity of the process with multiple etiologies 
Multidisciplinary approach
Inflammation Metabolism
Neurotransmitters
Vascular damage
Hormones
Cognitive dysfunctions
Chemotherapy
Neurogenesis
Anemia
Other medications
Gènes
Emotional status
Cancer
Neuropsychological tests
Neuro-imaging
Animals models
Programme
Programme
ICCTF International Cognition and Cancer Task Force Conference
March 15
15--17
th
2012 – PARIS - FRANCE