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Modafinil improved cognitive function in breast cancer survivors

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Modafinil improved memory and attention in breast cancer survivors who underwent chemotherapy and/or radiation, improving their overall quality of life, according to data from a phase-2 analysis.

First, researchers conducted a phase-1 randomized clinical trial of 76 breast cancer survivors aged 33 to 83 years. Participants were tested on speed of memory — a combination of speed of numeric working memory, spatial working memory, word recognition and picture recognition — and episodic memory. Using tests from the Cognitive Drug Research computerized cognitive assessment, the researchers examined memory and attention at baseline and after both phases were completed.

During phase 1, modafinil (Provigil, Cephalon) was administered in a 100-mg tablet once per day for the first three days, then two tablets totaling 200-mg open-label once per day for four weeks. It improved speed of memory (P=.0073) and quality of episodic memory (P<.0001) among patients.

Sixty-eight women went on to complete phase 2 of the trial. During phase 2, patients who had a positive response during phase 1 were randomly assigned to four additional weeks of modafinil 200 mg or placebo.

The researchers reported a cumulative improvement in speed of memory scores from baseline to week eight in the modafinil group (P=.029) compared with placebo (P=.116). Additionally, quality of episodic memory improved more in the modafinil group (P=.015) compared with placebo (P=.155).

Continuity of attention improved from baseline to week eight in about 70% of patients in the modafinil group compared with 52% in the placebo group; however, the difference was not significant.

“Although larger studies are needed to confirm these findings, the results of our secondary analysis of a trial of modafinil suggest that it can considerably improve some cognitive function measures in breast cancer survivors,” the researchers wrote.

Kohli S. Cancer. 2009;doi:10.1002/cncr.24287.

This faux sympathomimetic drug has potential multiple interactions with many drugs, so that PDR perusal should be performed before its use in patients.

– Harry S. Jacob, MD

HemOnc Today Chief Medical Editor