Over the past decade, immunotherapy has been gaining popularity as a treatment for many kinds of cancer, giving patients another option besides chemotherapy and radiation.
Immunotherapy boosts a person’s own immune system to identify and fight cancer cells that normally evade its defenses.
However, like traditional cancer treatments, immunotherapy may cause or exacerbate cognitive decline, especially in older adults. Because this treatment is much newer than chemotherapy or radiation, these potential side effects have not yet been widely studied.
Gee Su Yang, assistant professor at the UConn School of Nursing, has received a $60,000 CRISP (Clinical Research Innovation Seed Program) Award from the Office of the Vice President for Research to conduct a pilot study of how immunotherapy impacts cognitive function in older cancer patients.
“Research on the impact of immunotherapy on cognitive function is limited,” Yang says. “We don’t know just how immunotherapy affects their cognitive function. So, I hope to provide some preliminary evidence.”
Yang will collaborate with Dr. Upendra Hedge at the Carole and Ray Neag Comprehensive Cancer Center at UConn Health, Dr. Breno Diniz at the UConn Center on Aging, and Professors Nancy Redeker and Keith Bellizzi at UConn Storrs for this study.
Yang is working with a population of 24 men and women over the age of 60 with cancer. The group will contain both those receiving immunotherapy treatment, specifically immune checkpoint inhibitors, and those with the same cancer stage and type who are not, as a control group.
Immune checkpoint inhibitors are a type of immunotherapy treatment that blocks the checkpoints on T-cells, a critical part of the body’s immune system. These checkpoints tell the cells to stay turned “off” when there isn’t anything to attack, protecting healthy cells. But cancer cells can attach to these checkpoints and keep them off. By blocking the checkpoint, this immunotherapy treatment enables the T-cells to fight cancer cells.
This group will contain patients with melanoma, head and neck cancer, or other solid tumors, a critical consideration as much previous research on cancer-related cognitive impairment (CRCI) has been limited to breast cancer survivors.
“Generating data on the cognitive health of patients receiving immunotherapy, and particularly in cancers other than breast cancer, will advance the field,” Yang says.
Yang will use objective and subjective measures to assess the cognitive functioning of patients receiving immunotherapy and the control group before and then three months later during treatment.
“I want to examine longitudinal changes in cognitive function as well as frailty, comorbidities, comorbid symptoms, and genetic and neurodegenerative disease factors that predict cognitive changes among older adults with cancer,” Yang says.
Yang will take blood samples from participants to check for certain known biomarkers associated with Alzheimer’s and other neurodegenerative diseases.
Yang will also screen for the APOE4 genotype. This variant has been associated with cognitive function decline in people with cancer.
“I want to see how this genetic information could provide some prediction of cognitive changes since we know this genotype has a significant association with cognitive impairment in cancer patients,” Yang says.
As a registered nurse, Yang is interested in how this research can translate to individualized patient care.
“I think understanding how immunotherapy can affect the cognitive performance of older patients may aid in tailoring their treatment strategy and the development of a more comprehensive support plan for treatment decisions and potential interventions to preserve or mitigate the impact of immunotherapy on cognitive well-being,” Yang says. “I really want my study to be helpful and beneficial in improving patients’ cancer survivorship and contribute to improving their quality of life.”
