Abstract P5-17-04: Long term hair loss in patients with early breast cancer receiving docetaxel chemotherapy

  • Cheshire and Wirral Partnership Foundation Trust

Abstract P5-17-04: Long term hair loss in patients with early breast cancer receiving docetaxel chemotherapy

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Background There is increasing recognition that a small number of patients receiving docetaxel-containing regimes for early breast cancer (EBC), experience permanent alopecia. However, there is little data to inform discussions with patients regarding this serious late side effect. The aim of this study was determine the incidence, the site, the extent, and duration of the hair loss. Methods A postal questionnaire was sent (in October 2013) to patients who had received docetaxel during 2010, in the neo/adjuvant settings for EBC at our regional cancer centre. This comprised questions relating to scalp hair loss (using the Ludwig scale to provide a pictorial description of the pattern of hair loss), hair loss to other parts of the body, hair products used, and any comments that the respondents wished to add about their experience of hair loss. Univariate and multivariate analyses were undertaken to determine any other risk factors for persistent alopecia. Results 134 of 189 (71%) questionnaires were returned. Of those responding, 72 patients were pre-, 10 were peri- and 52 post-menopausal. 26 patients were taking anastrazole, 14 letrozole, 74 tamoxifen and 20 no adjuvant hormones. Of the respondents, 99 (74.4%) patients had no significant scalp hair loss, and 21 (15.8%) had significant scalp hair loss. 13 (9.8%) of patients gave equivocal responses and 1 patient did not answer the scalp hair loss question. 16 patients in the study were using products such as wigs and hair extensions. 5 patients reported no regrowth of eyebrows, 2 patients reported no eyelash regrowth, 6 no regrowth of nostril hair and 14 no regrowth to other parts such as legs. Univariate and multivariate analyses showed no significant associations with other patient and treatment characteristics (eg adjuvant endocrine therapy). Patients’ observations regarding the social and emotional consequences of permanent hair loss confirmed a significant impact on quality of life. Conclusions This retrospective questionnaire study confirms that long term significant scalp alopecia (here lasting for up to 3.5 years following completion of chemotherapy) may affect 10-15% of patients following docetaxel for EBC (taking into consideration a potential bias for no hair loss in the non- responders). This rate is higher than previous estimates. Long term hair loss to other parts of the body was also widely reported. This appears to be unrelated to other patient and treatment characteristics. Long term hair loss had a significant impact on quality of survival. This is an important quality of life issue for patients which merits prospective study to confirm incidence, to identify effective preventive and management strategies. This risk should be discussed routinely (as part of the process of informed consent) with all patients embarking upon docetaxel as a component of management of EBC. Citation Format: Nicola J Thorp, Felicity Swift, Donna Arundell, Helen Wong. Long term hair loss in patients with early breast cancer receiving docetaxel chemotherapy [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-17-04.

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... Incomplete hair regrowth 6 months following chemotherapy completion in patients who received cytotoxic chemotherapy is defined as persistent chemotherapy-induced alopecia (pCIA) [8]. pCIA has a reported incidence of up to 30% [9] in women treated with taxane-based chemotherapy (paclitaxel and docetaxel) [8,[10][11][12][13] and cyclophosphamide-based chemotherapy [11,14,15]. ...
... Breast Cancer Research and Treatment (2019) 174:[15][16][17][18][19][20][21][22][23][24][25][26] ...
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Purpose To provide dermatologists and oncologists with a foundation for practical understanding and uses of 5α-reductase inhibitors and spironolactone for breast cancer patients and survivors receiving endocrine therapies (ETs), including the effect of these treatments on sex hormone levels, any reported drug interactions, and any risk of malignancy. Methods All published studies from January 1978 through April 2018 were considered, using databases such as PubMed, Google Scholar, and Science Direct. Forty-seven studies were included in this review. Results There is no evidence of interactions between 5α-reductase inhibitors and spironolactone with ETs used in breast cancer. Sex hormone alteration with 5α-reductase inhibitor or spironolactone use is variable. Three randomized controlled trials, 1 case–control study, and 6 retrospective cohort studies, including 284 female patients, studied the effects of 5α-reductase inhibitors on serum estrogen levels. Levels were increased in 97 of 284 (34%) patients, decreased in 15 of 284 (5.3%) patients, and unchanged in 162 of 284 (57%) patients. Four retrospective cohort studies, 1 case study, and 1 double-blinded crossover study, including 95 female patients, assessed the effect of spironolactone on estrogen levels. Levels were increased in 25 of 95 (26%) patients, decreased in 6 of 95 (6.3%) patients, and unchanged in 64 of 95 (67%) patients. Ultimately, most patients did not have a significant alteration in the level of estrogen when using 5α-reductase inhibitors or spironolactone. No consistent evidence of increased risk of female breast cancer while on spironolactone was reported in 3 studies including 49,298 patients; the risk of breast cancer with the use of 5α-reductase inhibitors has not been studied. Conclusions Most patients did not show increased estrogen levels with spironolactone and there were no data suggesting increased risk of breast cancer. Based on hormonal and pharmacological activity, spironolactone may be considered for further research on alopecia and hirsutism in breast cancer patients.
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