Hair Loss from Endocrine Therapy Breast Cancer Treatment

An American study has investigated potential treatment for hair loss caused by endocrine therapy for breast cancer patients, with a view to improving the lives of those receiving it.

This research marks the first time endocrine therapy-induced alopecia (EIA) has been officially explored in this way.

A study sponsored by the Memorial Sloan Kettering Cancer Centre in New York is also aiming to explore the impact of cancer treatment on a patient's quality of life. It has been gathering data from women with breast cancer since 2015.

Tamoxifen breast cancer endocrine induced alopecia hair lossEndocrine-induced alopecia

As noted on the JAMA Dermatology website, the study was carried out from 1 January 2009 to 31 December 2016.

It involved 112 patients with breast cancer who had also been diagnosed with endocrine-induced alopecia. Subjects ranged from 34 to 90 years of age. Findings from the study reported 'Alopecia was attributed to aromatase inhibitors in 75 patients (67%) and tamoxifen in 37 (33%)'.

The patient's quality of life was measured using the Hairdex Questionnaire. Despite most cases of EIA being mild, the researchers explained how patients reported a 'significant negative emotional impact', testament to the negative psychological effects losing hair can have on women.

Hairloss during cancer treatment, particularly chemotherapy, is usually caused by Anagen Effluvium. However, as this study's investigators revealed, the appearance of 'vellus hairs and intermediate- and thick-diameter terminal hair shafts' suggests the participants's pattern of hair loss was similar to Androgenic Alopecia, more commonly referred to as Female Pattern Hair Loss.

What exactly is meant by this isn't specified in the study, though whilst it could refer to the location - genetic hair loss only affects the vertex - it is more likely to be referring to the fact that this hereditary condition causes thinning hair. A common form of temporary hair thinning caused by illness and medications is something called Chronic Telogen Effluvium - something for which treatment is available, though only once the individual patient's oncologist has given their consent.

Researchers emphasise the role androgens and estrogens, the male and female sex hormones, play in the hair growth process and why endocrine therapy - also known hormone therapy - which adds, blocks or removes hormones, may cause hair loss:

'When endocrine receptor activation and pathway signaling are blocked, dihydrotestosterone levels increase, and this action may contribute to the induction of alopecia in susceptible women receiving ET [endocrine therapy]'.

Dihydrotestosterone, or DHT, is found to be a key cause of hair shedding in genetically-predisposed individuals. As a result the investigators hypothesise that those receiving endocrine therapy may benefit from current treatments for hereditary hair loss, such as minoxidil.

Minoxidil Dropper with liquidFindings of the study and current options

Of the 46 patients who were assessed for their response to the drug, hair growth was observed in 37. Given the negative correlation between hair loss and quality of life, this medication may improve the lives of women undergoing endocrine therapy in the future.

It must be noted the shedding caused by chemotherapy differs from endocrine therapy-induced hair loss: patients looking to prevent hair loss during treatment, or at least minimise chemo-related hair fall, can often use scalp cooling systems known as cold caps. These chill the scalp to extremely low temperatures which restricts the flood of blood - and thus chemo drugs - to the hair follicles.

Minoxidil is MHRA licensed and FDA approved to treat Female Pattern Baldness. However, results have also been seen when treating other hairloss conditions, including Chronic Telogen Effluvium, Alopecia Areata and Traction Alopecia, with the topical medication.

If concerned about losing hair during hormone therapy then speaking to an oncologist should be the first priority. If wanting to explore hair loss treatment then they can provide a letter of recommendation. At Belgravia an oncologist's letter of authorisation is always required for anyone who has received cancer treatment.

Hair lost to cancer tends to grow back naturally within 12 months of treatment ending, but for anyone looking for help in accelerating the hair regrowth process, it is advisable to speak to a hair loss specialist who, with the relevant oncologist's assistance, can provide a suitable solution tailored to the precise needs - including level of shedding and medical profile - of the affected individual.

Larger clinical trials would be needed to prove the efficacy, safety and tolerability of minoxidil when treating endocrine-induced alopecia, and anyone with cancer-related hair loss is advised not to try over-the-counter medications in a bid to regrow their hair, without consulting their doctor or oncologist first.

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The Belgravia Centre

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