Alopecia With Endocrine Therapies in Patients With Cancer

Saggar, Vishal Raj; Wu, Shenhong; Dickler, Maura N.; Lacouture, Mario E.

doi:10.1634/theoncologist.2013-0193

Cited by 57 publications

(40 citation statements)

References 59 publications

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“…[35] Indirect evidence for a protective effect of oestrogens on human hair growth comes from the increasing prevalence of FPHL following the menopause, the prolongation of anagen during pregnancy [36] and reports of hair loss in women taking tamoxifen or aromatase inhibitors for the treatment of breast cancer. [37] One study found lower oestrogen/androgen ratios in premenopausal women with FPHL compared to a control group, suggesting a protective effect of oestrogen on hair loss, although the number of subjects was quite small. [38] Interestingly, androgen levels were slightly lower in the FPHL subjects than in controls although the difference was not significant.…”

Section: Sex Steroid Hormonesmentioning

confidence: 99%

Genetics and other factors in the aetiology of female pattern hair loss

Redler

Messenger

Betz

2017

Experimental Dermatology

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Pattern hair loss is the most common form of hair loss in both women and men. Male pattern hair loss, also termed male androgenetic alopecia (M-AGA), is an androgendependent trait that is predominantly genetically determined. Androgen-mediated mechanisms are probably involved in female pattern hair loss (FPHL) in some women but the evidence is less strong than in M-AGA; other non-androgenic pathways, including environmental influences, may contribute to the aetiology. Genome-wide association studies have identified several genetic loci for M-AGA and have provided better insight into the underlying biology. However, the role of heritable factors in and it has long been assumed that FPHL shares the same aetiology;hence, the term "female androgenetic alopecia" is often applied to this condition. However, the role of androgens in causing FPHL is less clear than in men. The genetic studies performed so far have not led to any firm conclusions but rather suggest different pathways for M-AGA and FPHL.In this review, we summarize what is known about the aetiology of FPHL and its relationship to M-AGA. Our main focus is on the results of genetic studies performed within the last decade. We also discuss the role of endocrine and other factors in the pathogenesis. | PREVALENCEPublished data on the prevalence of FPHL show some variation between studies, perhaps reflecting the difficulty in classifying mild forms of the condition. However, all show an increasing prevalence with age. Studies in women of white European ethnicity in the USA, [2] UK [3] and Australia [4] record a prevalence of 3%-12% in the third decade, rising to 14%-28% in the sixth decade and 29%-56%

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Section: Sex Steroid Hormonesmentioning

confidence: 99%

Genetics and other factors in the aetiology of female pattern hair loss

Redler

Messenger

Betz

2017

Experimental Dermatology

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“…While more than half of women with breast cancer report alopecia as the most traumatic adverse event during treatment, hormone therapy-induced alopecia (HTIA) is still largely underreported, with only 6% of studies of tamoxifen reporting it [ 60 ]. In a meta-analysis of 35 studies ( n = 13,415 patients) the incidence of all-grade HTIA ranged from 0% with anti-androgen therapies to 25% with selective estrogen receptor modulators (SERMs), corresponding to an overall incidence of 4.4% [ 60 ]. In a retrospective study of the data for 112 patients treated with SERMs/aromatase inhibitors, HTIA was most often (92%) characterized by an androgenic alopecia pattern and low severity grade [ 61 ].…”

Section: Hair Toxicitiesmentioning

confidence: 99%

Toxic Side Effects of Targeted Therapies and Immunotherapies Affecting the Skin, Oral Mucosa, Hair, and Nails

2018

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Targeted therapies and immunotherapies are associated with a wide range of dermatologic adverse events (dAEs) resulting from common signaling pathways involved in malignant behavior and normal homeostatic functions of the epidermis and dermis. Dermatologic toxicities include damage to the skin, oral mucosa, hair, and nails. Acneiform rash is the most common dAE, observed in 25–85% of patients treated by epidermal growth factor receptor and mitogen-activated protein kinase kinase inhibitors. BRAF inhibitors mostly induce secondary skin tumors, squamous cell carcinoma and keratoacanthomas, changes in pre-existing pigmented lesions, as well as hand-foot skin reactions and maculopapular hypersensitivity-like rash. Immune checkpoint inhibitors (ICIs) most frequently induce nonspecific maculopapular rash, but also eczema-like or psoriatic lesions, lichenoid dermatitis, xerosis, and pruritus. Of the oral mucosal toxicities observed with targeted therapies, oral mucositis is the most frequent with mammalian target of rapamycin (mTOR) inhibitors, followed by stomatitis associated to multikinase angiogenesis and HER inhibitors, geographic tongue, oral hyperkeratotic lesions, lichenoid reactions, and hyperpigmentation. ICIs typically induce oral lichenoid reactions and xerostomia. Targeted therapies and endocrine therapy also commonly induce alopecia, although this is still underreported with the latter. Finally, targeted therapies may damage nail folds, with paronychia and periungual pyogenic granuloma distinct from chemotherapy-induced lesions. Mild onycholysis, brittle nails, and a slower nail growth rate may also be observed. Targeted therapies and immunotherapies often profoundly diminish patients’ quality of life, which impacts treatment outcomes. Close collaboration between dermatologists and oncologists is therefore essential.

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“…appear to play a role [115, 116]. It must be noted that the long-term (2–10 years) adjuvant endocrine-based anticancer therapies (antioestrogens and aromatase inhibitors) may also cause and/or exacerbate hair loss [120]. …”

Section: Hair and Nail Changesmentioning

confidence: 99%

Dermatological adverse events with taxane chemotherapy

Sibaud

LeBoeuf

Roché

et al. 2016

European Journal of Dermatology

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177

179

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Taxanes (docetaxel and paclitaxel) are among the most commonly prescribed anticancer drugs approved for the treatment of metastatic or locally advanced breast, non-small cell lung, prostate, gastric, head and neck, and ovarian cancers, as well as in the adjuvant setting for operable node-positive breast cancers. Although the true incidence of dermatological adverse events (AEs) in patients receiving taxanes is not known, and has never been prospectively analysed, they clearly represent one of the major AEs associated with these agents. With an increase in the occurrence of cutaneous AEs during treatment with novel targeted and immunological therapies when used in combination with taxanes, a thorough understanding of reactions attributable to this class is imperative. Moreover, identification and management of dermatological AEs is critical for maintaining the quality of life in cancer patients and for minimizing dose modifications of their antineoplastic regimen. This analysis represents a systematic review of the dermatological conditions reported with the use of these drugs, complemented by experience at comprehensive cancer centres. The conditions reported herein include skin, hair, and nail toxicities. Lastly, we describe the dermatological data available for the new, recently FDA-and EMA- approved, solvent-free nab-paclitaxel.

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Alopecia With Endocrine Therapies in Patients With Cancer

Cited by 57 publications

References 59 publications

Genetics and other factors in the aetiology of female pattern hair loss

Genetics and other factors in the aetiology of female pattern hair loss

Toxic Side Effects of Targeted Therapies and Immunotherapies Affecting the Skin, Oral Mucosa, Hair, and Nails

Dermatological adverse events with taxane chemotherapy

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