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Comparative Study
. 2019 Jun 1;155(6):724-728.
doi: 10.1001/jamadermatol.2018.5071.

Assessment of Quality of Life and Treatment Outcomes of Patients With Persistent Postchemotherapy Alopecia

Azael Freites-Martinez  1   2 , Donald Chan  1 , Vincent Sibaud  3 , Jerry Shapiro  4 , Gabriella Fabbrocini  5 , Antonella Tosti  6 , Juhee Cho  7   8 , Shari Goldfarb  9   10 , Shanu Modi  9   10 , Devika Gajria  9   10 , Larry Norton  9 , Ralf Paus  6   11 , Tessa Cigler  10 , Mario E Lacouture  1
Affiliations
Comparative Study

Assessment of Quality of Life and Treatment Outcomes of Patients With Persistent Postchemotherapy Alopecia

Azael Freites-Martinez et al. JAMA Dermatol. .

Erratum in

  • Missing Conflict of Interest Disclosure.
    [No authors listed] [No authors listed] JAMA Dermatol. 2019 Jun 1;155(6):757. doi: 10.1001/jamadermatol.2019.0673. JAMA Dermatol. 2019. PMID: 30969343 Free PMC article. No abstract available.

Abstract

Importance: Persistent alopecia occurs in a subset of patients undergoing chemotherapy, yet the quality of life (QOL) of these patients and their response to therapy have not been described in a large patient cohort.

Objective: To characterize the clinical presentation of patients with persistent chemotherapy-induced alopecia (pCIA) or endocrine therapy-induced alopecia after chemotherapy (EIAC) and their QOL and treatment outcomes.

Design, setting, and participants: A retrospective multicenter cohort of 192 women with cancer treated with cytotoxic agents who received a clinical diagnosis of persistent alopecia (98 with pCIA and 94 with EIAC) between January 1, 2009, and July 31, 2017, was analyzed. All patients were from the dermatology service in 2 comprehensive cancer centers and 1 tertiary-care hospital. Data on demographics, chemotherapy regimens, severity, clinical patterns, and response to hair-growth promoting agents were assessed. Data from the Hairdex questionnaire were used to assess the QOL of patients with alopecia.

Main outcomes and measures: The clinical presentation, response to dermatologic therapy, and QOL of patients with pCIA were assessed and compared with those of patients with EIAC.

Results: A total of 98 women with pCIA (median age, 56.5 years [range, 18-83 years]) and 94 women with EIAC (median age, 56 years [range, 29-84 years]) were included. The most common agents associated with pCIA were taxanes for 80 patients (82%); the most common agents associated with EIAC were aromatase inhibitors for 58 patients (62%). Diffuse alopecia was predominant in patients with pCIA compared with patients with EIAC (31 of 75 [41%] vs 23 of 92 [25%]; P = .04), with greater severity (Common Terminology Criteria for Adverse Events, version 4.0, grade 2) among patients with pCIA (29 of 75 [39%] vs 12 of 92 [13%]; P < .001). A negative emotional effect was reported by both groups. After treatment with topical minoxidil or spironolactone, moderate to significant improvement was observed for 36 of 54 patients with pCIA (67%) and for 32 of 42 patients with EIAC (76%).

Conclusions and relevance: Persistent chemotherapy-induced alopecia is frequently more severe and diffuse when compared with EIAC, and both groups of patients experienced a negative effect. A modest benefit was observed with dermatologic therapy. Additional studies are warranted to develop effective strategies for prevention and effective therapy for pCIA and EIAC.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Sibaud reported serving as a consultant to Novartis, Bristol-Myers Squibb, Roche, and Pierre Fabre. Dr Shapiro reported serving as a consultant to Aclaris, Samumed, Incyte, Replicel Life Sciences, Shook, Hardy, and Bacon LLP who represent Sanofi Aventis US LLC. Dr Tosti reported serving as a consultant to Procter & Gamble, DS Laboratories, Monat, Almirall, Andrews & Thornton (representing plaintiffs in the taxotere litigation), and Pfizer; and serving as a principal investigator for Incyte and Nutrifol. Dr Goldfarb reported serving as a consultant to Adgero Biopharmaceuticals, AMAG Pharmaceuticals, Procter & Gamble, and Valeant Women’s Health Pharmaceuticals. Dr Paus reported serving as a consultant and receiving research funding from Giuliani/Italy and Unilever/UK; and being founder/owner of Monasterium Laboratory/Germany. Dr Lacouture reported serving as a consultant or speaking for Legacy Healthcare Services, Adgero Bio Pharmaceuticals, Amryt Pharmaceuticals, Celldex Therapeutics, Debiopharm, Galderma Research and Development, Johnson and Johnson, Novocure Inc, Lindi, Merck, Sharp and Dohme Corp, Helsinn Healthcare SA, Janssen Research & Development LLC, Menlo Therapeutics, Novartis Pharmaceuticals Corporation, F. Hoffmann–La Roche AG, AbbVie Inc, Boehringer Ingelheim Pharma Gmbh & Co KG, Allergan Inc, Amgen Inc, E. R. Squibb & Sons, LLC, EMD Serono Inc, AstraZeneca Pharmaceuticals LP, Genentech Inc, Leo Pharma Inc, Seattle Genetics, Bayer, Manner, SAS, Lutris, Pierre Fabre, Paxman Coolers, Adjucare, Dignitana, Biotechspert, Teva Mexico, Parexel, OnQuality Pharmaceuticals Ltd, Novartis, Our Brain Bank, and Takeda Millenium; and receiving research funding from Veloce, US Biotest, Berg, Bristol-Myers Squibb, Lutris, Paxman, and Novocure. No other disclosures were reported.

Figures

Figure.
Figure.. Flow Diagram for Patient Inclusion and Case Definition
EIA indicates endocrine therapy–induced alopecia; EIAC, endocrine therapy–induced alopecia after chemotherapy, and pCIA, persistent chemotherapy-induced alopecia.
See this image and copyright information in PMC

References

    1. Freites-Martinez A, Shapiro J, van den Hurk C, et al. CME part 2: hair disorders in cancer survivors: persistent chemotherapy-induced alopecia, persistent radiotherapy-induced alopecia, and hair growth disorders related to endocrine therapy or cancer surgery [published online April 13, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.03.056 - DOI - PMC - PubMed
    1. Kang D, Kim I-R, Lee D-Y, et al. Incidence of permanent chemotherapy-induced alopecia among breast cancer patients: a five-year prospective cohort study. Ann Oncol. 2017;28(suppl_10):mdx655.022. doi: 10.1093/annonc/mdx655.022 - DOI
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    1. Freites-Martinez A, Shapiro J, Chan D, et al. Endocrine therapy–induced alopecia in patients with breast cancer. JAMA Dermatol. 2018;154(6):670-675. doi: 10.1001/jamadermatol.2018.0454 - DOI - PMC - PubMed
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