Alzheimer’s biomarkers in oncology: The impact of cancer treatment on neurodegenerative diagnostic disparities across populations.

Abstract

e14048 Background: The intersection of oncology and neurodegenerative disorders has illuminated complex interactions existing among cancer treatments, cognitive decline, and Alzheimer's disease (AD) biomarkers. Even under the circumstance that we see differences in levels of AD biomarkers across ethnoracial groups, in addition to the cognitive impacts of cancer related cognitive decline (CRCD), cancer survivors may require consideration for an individualized and personalized approach to diagnostics. This systematic review aims to synthesize evidence around the impacts of cancer treatments on AD biomarker levels in cognitive outcomes within a heterogeneous population. Methods: A systematic review was conducted, following guidance from PRISMA. The search of the following databases were completed: PubMed, EMBASE, Scopus, and Cochrane, using literature published from the year 2010 ending in 2024. The studies included analyzed cognitive outcomes; AD biomarker levels (that included amyloid, tau, and APOE genotype); and ethnoracial differences in patients with cancer. We extracted data related to the cancer treatment, biomarker levels, the testing for cognitive purposes, and neuropathological outcomes. Ethnoracial differences were analyzed in consideration to the following minority groups: African Americans, Mexican American, and non-Hispanic White. Results: A total of 25 studies and 3,809 participants were included. Compared to participants without cancers, individuals diagnosed who were cancer survivors showed lower odds of an AD diagnosis, and less burden of AD pathology in the brain subsequently. Individuals who received chemotherapy had a lower chance of dementia than cancer individuals who did not receive treatments. Nonetheless, cancer related neurologic pathology, including cerebral amyloid angiopathy, neuritic plaques, and neurofibrillary tangles, was lower in survivors, making AD diagnostics, especially with biomarkers more difficult claiming them to be biased towards AD diagnosis. Ethnoracial characteristics were noted, as African American samples showed less burden of AD biomarkers raising the need for population specific diagnostic criteria. Conclusions: Our review highlights significant disparities in AD biomarkers and cognitive outcomes among cancer survivors, particularly across ethnoracial lines. Cancer treatments appear to modulate AD pathology, suggesting the need for ethnoracial-specific biomarker validation and diagnostic approaches. This underscores the importance of precision medicine in addressing disparities in neurodegenerative diagnostics, particularly for populations with a history of cancer.