Vascular endothelial growth factor inhibitors and cognitive impairment: evidence and controversies.

INTRODUCTION: Chemotherapy-induced cognitive impairment, or 'chemobrain,' has been well established in the literature. However, neurocognitive toxic effect induced by targeted therapies such as anti-angiogenic agents is poorly investigated. Recently, emerging evidence suggests vascular endothelial growth factor (VEGF) to have a possible role in brain cognition giving rise to concerns whether VEGF inhibitors (VEGFIs) may induce neurotoxic effect on cancer patients' cognitive function. AREAS COVERED: The aim of this review was to evaluate the plausible mechanisms underlying VEGF and cognition, and to highlight the evidence and controversies surrounding the cognitive issues associated with the use of VEGFIs. EXPERT OPINION: This review paper has brought attention to the potential cognitive issues associated with the use of VEGFIs and has added a new, unexplored dimension to the problem of cancer treatment-related cognitive changes. However, the lack of evidence warrants the need for more well-designed studies to quantify the prevalence and severity of VEGFI-induced cognitive impairment in the cancer population, and to establish the role of VEGF in human cognitive function.