Tumour brain: pre‐treatment cognitive and affective disorders caused by peripheral cancers

People that develop extracranial cancers often display co-morbid neurological disorders, such as anxiety, depression and cognitive impairment, even before commencement of chemotherapy. This suggests bidirectional crosstalk between non-CNS tumours and the brain, which can regulate peripheral tumour growth. However, the reciprocal neurological effects of tumour progression on brain homeostasis are not well understood. Here, we review brain regions involved in regulating peripheral tumour development and how they, in turn, are adversely affected by advancing tumour burden. Tumour-induced activation of the immune system, blood–brain barrier breakdown and chronic neuroinflammation can lead to circadian rhythm dysfunction, sleep disturbances, aberrant glucocorticoid production, decreased hippocampal neurogenesis and dysregulation of neural network activity, resulting in depression and memory impairments. Given that cancer-related cognitive impairment diminishes patient quality of life, reduces adherence to chemotherapy and worsens cancer prognosis, it is essential that more research is focused at understanding how peripheral tumours affect brain homeostasis

Cardiovascular and Central Nervous System Toxicity by Anticancer Drugs in Breast Cancer Patients

Breast cancer is one of the most malignant diseases, associated with high rate mortality. In this chapter a particular attention is paid on cardiovascular and central nervous system toxicity induced by chemotherapeutic agents used for both primary and metastatic treatment of this life-threatening pathology. With respect to traditional drugs, including anthracyclines, taxanes, and fluoropyrimidines, the more recent targeted therapies, such as human epidermal growth factor receptor 2 (HER2) and vascular endothelial growth factor (VEGF), aimed to ameliorate anticancer activity and to reduce toxic effects by affecting more specific molecular sites. However, despite the improvement in breast cancer treatment, these novel drugs were also found to be associated, even if at a lesser extent, with important side effects, such as cardiotoxicity, with consequent heart failure. For this reason, the cardiovascular and brain safety profile of all anticancer drugs and protocols remains important items to be carefully evaluated in breast cancer patients