Nicotinic Treatment of Post-Chemotherapy Subjective Cognitive Impairment: A Pilot Study

Studies have suggested that chemotherapy treatment for breast cancer may change the way the brain functions. As a result, patients who receive chemotherapy for breast cancer may experience problems with their attention, learning, and memory that they did not have before receiving chemotherapy. The investigators have found that nicotine treatment can help other types of patients with similar difficulties with attention, learning, and memory. Nicotine is a naturally occurring substance found in tobacco and is known to interact with nerve cells in the brain that are important for functions like learning and memory, and has been studied in a number of disorders. This study is designed to test whether nicotine treatment is helpful for learning and memory problems after chemotherapy for breast cancer.

This study will be a randomized, placebo-controlled pilot study to evaluate the effect of transdermal nicotine to 1) reduce subjective complaints and 2) enhance cognitive performance on laboratory measures of cognitive performance in breast cancer patients with persistent chemotherapy-related cognitive impairment (CRCI), a condition also known as "chemo brain." Participants will be randomized to either placebo or active compound (50/50) for the 6-week treatment portion of the study. Participants will be assessed before, during, and at the end of treatment. At the end of the 8-week study, participants will have the option to take part in the open-label portion of the study for an additional 6 weeks.

Inclusion criteria

• All participants will:

• Be between 35 and 80 years of age,
• Have been diagnosed with noninvasive or invasive (Stage 1, 2, or 3A) breast cancer,
• Have undergone treatment with systemic chemotherapy within the last 1-5 years,
• Endorse persistent CRCI subjective complaints,
• Be non-smokers (no nicotine use within the last 5 years),
• Have no active cardiac, neurologic, or psychiatric illness, and
• Fluent in and able to read English.

Exclusion criteria

• Participants will be excluded for:

• Any active neurologic and/or psychiatric disease, history of significant head trauma followed by persistent neurologic deficits, or known structural brain abnormalities,
• Current major depression or another major psychiatric disorder as described in DSM-5 (use of CNS active medications (e.g. antidepressants) will be permitted, provided dosing has been stable for at least 3 months),
• Any history of alcohol or substance abuse or dependence within the past 2 years (DSM-5 criteria),
• Any significant systemic illness or unstable medical condition which could lead to difficulty complying with the protocol including:
• History of myocardial infarction in the past year or unstable, severe cardiovascular disease including angina or CHF with symptoms at rest, or clinically significant abnormalities on the ECG
• Clinically significant and/or unstable pulmonary, gastrointestinal, hepatic, or renal disease
• Insulin-requiring diabetes or uncontrolled diabetes mellitus,
• Uncontrolled hypertension (systolic BP> 170 or diastolic BP> 100), 5. Use of any investigational drugs within 30 days or 5 half-lives, whichever is longer, prior to screening, and 6. Use of any drugs with pro-cholinergic properties (e.g. donepezil).