The Potential Role of Nutraceuticals as an Adjuvant in Breast Cancer Patients to Prevent Hair Loss Induced by Endocrine Therapy

Abstract

Nutraceuticals, natural dietary and botanical supplements offering health benefits, provide a basis for complementary and alternative medicine (CAM). Use of CAM by healthy individuals and patients with medical conditions is rapidly increasing. For the majority of breast cancer patients, treatment plans involve 5–10 yrs of endocrine therapy, but hair loss/thinning is a common side effect. Many women consider this significant, severely impacting on quality of life, even leading to non-compliance of therapy. Therefore, nutraceuticals that stimulate/maintain hair growth can be proposed. Although nutraceuticals are often available without prescription and taken at the discretion of patients, physicians can be reluctant to recommend them, even as adjuvants, since potential interactions with endocrine therapy have not been fully elucidated. It is, therefore, important to understand the modus operandi of ingredients to be confident that their use will not interfere/interact with therapy. The aim is to improve clinical/healthcare outcomes by combining specific nutraceuticals with conventional care whilst avoiding detrimental interactions. This review presents the current understanding of nutraceuticals beneficial to hair wellness and outcomes concerning efficacy/safety in breast cancer patients. We will focus on describing endocrine therapy and the role of estrogens in cancer and hair growth before evaluating the effects of natural ingredients on breast cancer and hair growth.

Nutraceuticals Known to Promote Hair Growth Do not Interfere with the Inhibitory Action of Tamoxifen in MCF7, T47D and BT483 Breast Cancer Cell Lines

“…However, an important question to address with potential SERMs is whether they can they compete with another SERM, in this case tamoxifen. This is of particular significance for women that may be taking even non-phytoestrogenic nutraceuticals to prevent endocrine therapy induced hair loss [23]. Tamoxifen is a non-steroidal triphenylethylene prescribed to pre-menopausal women for the hormonal treatment of ER positive breast cancer.…”

“…Nutritional factors play an important role in hair growth and shedding, with current adjuvant therapies for hair thinning encompassing vitamin supplementation e.g., vitamin D, E, C, folic acid [19], or omega-3 fatty acids, which improve hair density, reducing the percentage of resting hair follicles [20]. There is increasing evidence that a plethora of plant-derived nutraceuticals including resveratrol, saw palmetto, maca, curcumin, tocotrienols, ashwagandha, horsetail, astaxanthin, kelp, annurca apple fruits, safflower and ginseng, can have beneficial effects on hair growth [21][22][23][24]. Some e.g., saw palmetto are competitive, nonselective inhibitors of 5α-reductase [25], the key enzyme required in the development of androgenetic alopecia [26].…”

“…However, there are wide-ranging reports that nutraceuticals with beneficial effects on hair growth, including curcumin, tocotrienols, kelp and resveratrol, also exert an anti-proliferative effect on breast cancer cells [23]. Whether this is due to tissue selectivity, e.g., antagonistic SERM in breast cancer cells, or due to a higher affinity for ER remains to be established.…”

Nanocarrier-mediated curcumin delivery: An adjuvant strategy for CNS disease treatment

“…In the pursuit of more effective CNS disease treatments, adjuvant therapy using nutraceuticals has garnered attention, particularly due to its ability to enhance therapeutic responses. 51,52 Among these, curcumin has emerged as a promising candidate for CNS disorders due to its therapeutic activity against them as discussed in the previous section. 6,8 Importantly, curcumin’s role as a modulator of the multidrug resistance protein P-glycoprotein (Pgp), a key efflux transporter at the BBB, offers a unique avenue for addressing CNS drug delivery limitations.…”

Role of Medicinal plant‐derived Nutraceuticals as a potential target for the treatment of breast cancer

“…When cancer cells are exposed to metabolic and genotoxic stress as a result of progression and metastasis, and when therapy is accepted, autophagy transforms into tumor‐promoting activities by maintaining the survival of tumor cells. Hypoxia and acidic chemicals may induce metabolic pressure, while chemotherapy and radiation may induce genotoxic pressure (Dell'Acqua et al, 2020; Li, Jin, & Li, 2021; Marsh & Debnath, 2020). Autophagy may decrease sensitivity to anti‐cancer medicines, diminish organelle damage and DNA fragmentation, and preserve cellular integrity.…”