Will My Hair Fall Out Again After 2nd Recurrence of Chemo

Cureus. 2018 Jul; 10(7): e3056.

Persistent Alopecia in a Breast Cancer Patient Following Taxane Chemotherapy and Adjuvant Endocrine Therapy: Instance Report and Review of Post-treatment Hair Loss in Oncology Patients with Breast Cancer

Monitoring Editor: Alexander Muacevic and John R Adler

Tyler Werbel

¹ School of Medicine, University of California San Diego, San Diego, United states

Philip R Cohen

ⁱⁱ Dermatologist, San Diego Family unit Dermatology, San Diego, USA

Received 2018 Jul 19; Accepted 2018 Jul 27.

Abstract

Taxane chemotherapy and adjuvant endocrine therapy are commonly used in breast cancer patients following surgery. We describe a 59-yr-old woman with a triple-positive invasive correct breast cancer that was treated with surgery, radiation, chemotherapy, and adjuvant hormonal therapy. She subsequently developed scalp alopecia, with histopathological features of both androgenetic alopecia and baldness areata; the pilus loss did not resolve subsequently completion of her chemotherapy. Pregnant clinical improvement was observed with topical minoxidil therapy. PubMed was searched for the post-obit terms: alopecia, breast, cancer, chemotherapy, endocrine, hair, loss, minoxidil, permanent, and taxane. The papers containing these terms and their references were reviewed. Temporary hair loss is frequently observed following taxane chemotherapy; however, albeit uncommon, persistent or permanent alopecia may occur in women with chest cancer who have been treated with taxane chemotherapy and endocrine therapy. It may exist reasonable to initiate therapy with topical minoxidil in breast cancer patients who develop alopecia after treatment with either taxane chemotherapy or endocrine therapy alone or both.

Keywords: alopecia, breast, cancer, chemotherapy, endocrine, hair, loss, minoxidil, permanent, taxane

Introduction

Alopecia is a common adverse cutaneous event in oncology patients receiving antineoplastic therapy. Treatment-associated alopecia has been observed in patients receiving taxane chemotherapy, hormonal therapy, or both [1]. Nosotros describe a adult female who developed prolonged alopecia following treatment which included docetaxel and subsequent hormonal therapy who afterwards experienced hair regrowth after treatment with topical minoxidil.

Example presentation

A 59-twelvemonth-old woman presented for evaluation of scalp baldness. Her past medical history was meaning for PT1cN1mi estrogen receptor (ER)+, progesterone receptor (PR)+, human being epidermal growth cistron receptor (HER)2+ g3 invasive ductal carcinoma of the right breast diagnosed xv months earlier. She had been treated with bilateral lumpectomy with right-sided sentinel lymph node biopsy and started chemotherapy nine months earlier; she received pertuzumab, docetaxel, carboplatin, and trastuzumab every three weeks for six cycles and was maintained on trastuzumab 6 mg/kg every iii weeks for ane year. Three weeks after completing taxane chemotherapy, she began treatment with anastrozole ane mg daily (which was switched to tamoxifen 20 mg daily due to joint hurting). She was also treated with radiations therapy and is currently on neratinib 240 mg daily; neratinib is a tyrosine kinase inhibitor anticancer drug used to prevent recurrence in patients with early-phase HER2+ breast cancer who have finished at least ane year of mail-surgery trastuzumab therapy.

She noted hair loss starting time after her first course of systemic chemotherapy. It became more extensive throughout the residue of her treatment. She had non experienced any regrowth of scalp hair since the completion of chemotherapy nor during her current hormonal therapy.

Cutaneous examination revealed baldness of the scalp. The clinical presentation was most consistent with female person pattern alopecia with diffuse and nearly complete pilus loss on the central and vertex region with retention of hair on the occipital scalp. There was fractional, diffuse hair loss – to a lesser caste – on the parietal scalp bilaterally (Figure ​ ane). There was also loss of hair on the eyebrows, axillae, pubic region, and upper lip. However, these areas had already slowly started to show regrowth.

Alopecia in a chest cancer patient later taxane chemotherapy and adjuvant hormonal therapy

Top (A), dorsum (B), right (C), and left (D) views of the scalp of a 59-year-old woman with pilus loss (*) following taxane (docetaxel) chemotherapy and endocrine therapy (anastrozole followed by tamoxifen) for breast cancer treatment before starting topical minoxidil. The royal dots (arrows) on her right (C), and left (D) scalp are the biopsy sites.

Biopsies from the right and left sides of her parietal scalp, in areas of baldness with some preservation of follicles, were performed for horizontal and vertical sectioning. Both showed like pathologic changes of a non-scarring baldness. The predominant feature noted was extensive miniaturization of the pilus follicles; this change was most suggestive of androgenetic alopecia. However, other findings – present to a lesser extent – included pigment casts in pilus follicles, increased catagen to telogen ratio, and empty fibrous tracks; these changes may be observed in alopecia areata.

Correlation of the patient's history, clinical presentation, and pathologic findings supported a diagnosis of antineoplastic (chemotherapy and hormonal) treatment-associated baldness. Specifically, her features were consistent with those previously reported in patients with breast cancer after taxane chemotherapy and adjuvant hormonal therapy who adult permanent baldness [1]. Treatment was initiated with minoxidil v% foam to be topically practical to the scalp twice daily.

The patient returned for follow up 4 months later. She was pleased with the clinical outcome and had noticed increased scalp hair growth; however, she commented that she ever used minoxidil once daily and occasionally twice daily. In addition, hair growth on the eyebrows, axillae, and pubic expanse connected to demonstrate clinical improvement. She decided to go along treating her scalp in a similar manner.

Her subsequent follow-upwardly visit, six months later (after ten months of topical minoxidil therapy), showed additional hair regrowth. Specifically, the cardinal and vertex area of her scalp had thickening of her pilus; in add-on, there was new hair growth on the parietal regions bilaterally (Figure ​ 2). She continues to use v% minoxidil foam one time daily.

Minoxidil-responsive alopecia following treatment of a breast cancer female patient with taxane chemotherapy and adjuvant hormonal therapy

Height (A), dorsum (B), right (C), and left (D) views of the scalp of a 59-year-old adult female with partial regrowth of scalp hair after 10 months of topical minoxidil therapy; she had experienced baldness subsequently her breast cancer treatment which consisted of taxane (docetaxel) chemotherapy and endocrine (anastrozole followed by tamoxifen) therapy.

Discussion

Alopecia of the scalp is typically classified as scarring or non-scarring. Chemotherapy-induced alopecia is generally not-scarring. Hair loss following treatment with antineoplastic agents is likewise normally temporary and often presents with an anagen fetor blueprint [2-3].

Various patterns of scalp baldness have been described in breast cancer patients depending on whether they received chemotherapy, hormonal therapy, or both [4]. In add-on to anagen fetor, patients receiving but endocrine therapy (aromatase inhibitor or selective estrogen receptor modulator) have been observed to develop a pattern similar to androgenetic alopecia [5]. Additionally, permanent alopecia has been observed in some patients who received taxane chemotherapy and adjuvant hormonal therapy; in these individuals, the clinical and pathologic findings were similar to either alopecia areata, androgenetic baldness or both [1,6].

Our patient's form of therapy, clinical presentation, and pathologic findings are nearly consistent with those noted in patients receiving taxane chemotherapy and adjuvant hormonal therapy. The x women described by Fonia et al. all had permanent androgenetic baldness-like hair loss. Two of these women also demonstrated histopathologic findings suggestive of alopecia areata, but only i had patchy hair loss [1].

The report past Fonia et al. did non talk over any treatment interventions [one]. Although our patient is like to those described in this group, she had a partial comeback of her baldness following topical intervention with minoxidil five% foam. The positive therapeutic action of the topical minoxidil may have occurred since the pathologic features of her pare biopsies predominantly corresponded to androgenetic baldness. Indeed, it is interesting to speculate whether she would have had an even more than pronounced hair growth had she been meantime treated off-label with oral finasteride.

After her initial chemotherapy, while receiving hormonal therapy, she continued to receive trastuzumab 6 mg/kg every three weeks. Trastuzumab is a HER2-specific monoclonal antibody used to treat HER2+ cancers. Cutaneous agin events associated with this medication are uncommon, and alopecia, in particular, is rarely observed [vii]. Rare cutaneous side effects that have been reported in association with trastuzumab include tufted pilus folliculitis [eight] and psoriasis [9].

Adjuvant endocrine therapy is oftentimes used in the treatment of hormone receptor-positive breast cancer. Selective estrogen receptor modulators, such as raloxifene, tamoxifen, and toremifene, competitively inhibit estrogen receptors and are preferred for premenopausal women [10]. In addition, leuprolide, a gonadotropin-releasing hormone (GnRH) analog, can be used in premenopausal women in combination with other chemotherapy or endocrine therapy [11]. In comparing, aromatase inhibitors, including anastrozole, exemestane, and letrozole, reduce blood estrogen levels by inhibition of aromatase and are preferred for postmenopausal patients [12]. These treatments have like agin effect profiles, which include arthralgias, hot flashes, mood changes, and osteopenia [xi-12]; baldness has also been observed [5]. Serious cutaneous adverse effects associated with these therapies are rare, but angioedema, erythema nodosum, porphyria cutanea tarda, pseudolymphoma, radiation remember dermatitis, Steven-Johnson syndrome, subacute cutaneous lupus erythematosus, and vasculitis have been observed [xiii-17].

In women with breast cancer who developed endocrine therapy-induced alopecia, Freites-Martinez et al. observed significant clinical improvement in 80% (37/46) of the patients subsequently handling with topical minoxidil [5]. All individuals in this study had not previously received cytotoxic chemotherapy. Our patient considered her improvement with topical minoxidil to be pregnant. Therefore, it may be reasonable to initiate therapy with 5% minoxidil (foam or solution) twice daily in chest cancer patients who develop alopecia later on receiving endocrine therapy alone or following handling with taxane therapy.

Conclusions

Chemotherapy-induced baldness is a frequent side effect of treatment in oncology patients. Breast cancer patients may develop alopecia secondary to their chemotherapy (particularly if it includes a taxane) or adjuvant hormonal therapy or both. Our patient, who was treated with docetaxel and anastrozole followed by tamoxifen, developed persistent alopecia; her clinical presentation and pathology demonstrated a mixed blueprint of predominantly androgenetic alopecia with features of alopecia areata. She noted significant, admitting non complete, hair regrowth following handling with minoxidil 5% cream. It may exist reasonable to consider a prospective trial of empiric treatment with topical five% minoxidil in all breast cancer patients prior to, during, and post-obit their antineoplastic therapy.

Notes

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The authors have alleged that no competing interests exist.

Human being Ethics

Consent was obtained by all participants in this study

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6166916/