Chemotherapy-induced cognitive impairment: Mechanisms, emerging biomarkers, and therapeutic interventions

Chemotherapy remains a cornerstone of cancer treatment due to its ability to target rapidly proliferating cells. However, chemotherapy-induced cognitive impairment (CICI), commonly referred to as "chemo-brain," is a significant, yet under-recognized, side effect. Evidence suggests that chemotherapy-induced inflammation plays a central role in the development of CICI. Inflammatory cytokines, microglial activation, oxidative stress, mitochondrial dysfunction, and disruption of the gut microbiome are among the key mechanisms that contribute to cognitive deficits in cancer survivors. This narrative review explores these mechanisms in depth to provide a synopsis of emerging research and identify potential therapeutic interventions. Anti-inflammatory medications, microbiome-targeted therapies, and neuroprotective agents are promising avenues to mitigate cognitive dysfunction. Addressing CICI is crucial not only for improving quality of life but also for enhancing treatment adherence and long-term survivorship care. Future research should focus on biomarker discovery and clinical studies to refine and test comprehensive management strategies for CICI.