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Perez AM, Haberland NI, Miteva M, Wikramanayake TC. Chemotherapy-Induced Alopecia by Docetaxel: Prevalence, Treatment and Prevention. Curr Oncol 2024; 31:5709-5721. [PMID: 39330051 PMCID: PMC11431623 DOI: 10.3390/curroncol31090423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 09/19/2024] [Accepted: 09/20/2024] [Indexed: 09/28/2024] Open
Abstract
Docetaxel is a commonly used taxane chemotherapeutic agent in the treatment of a variety of cancers, including breast cancer, ovarian cancer, prostate cancer, non-small cell lung cancer, gastric cancer, and head and neck cancer. Docetaxel exerts its anti-cancer effects through inhibition of the cell cycle and induction of proapoptotic activity. However, docetaxel also impacts rapidly proliferating normal cells in the scalp hair follicles (HFs), rendering the HFs vulnerable to docetaxel-induced cell death and leading to chemotherapy-induced alopecia (CIA). In severe cases, docetaxel causes persistent or permanent CIA (pCIA) when hair does not grow back completely six months after chemotherapy cessation. Hair loss has severe negative impacts on patients' quality of life and may even compromise their compliance with treatment. This review discusses the notable prevalence of docetaxel-induced CIA and pCIA, as well as their prevention and management. At this moment, scalp cooling is the standard of care to prevent CIA. Treatment options to promote hair regrowth include but are not limited to minoxidil, photobiomodulation (PBMT), and platelet-rich plasma (PRP). In addition, a handful of current clinical trials are exploring additional agents to treat or prevent CIA. Research models of CIA, particularly ex vivo human scalp HF organ culture and in vivo mouse models with human scalp xenografts, will help expedite the translation of bench findings of CIA prevention and/or amelioration to the clinic.
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Affiliation(s)
- Aleymi M Perez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Lake Erie College of Osteopathic Medicine, Bradenton, FL 34211, USA
| | - Nicole I Haberland
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- College of Medicine, University of Central Florida, Orlando, FL 32827, USA
| | - Mariya Miteva
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Tongyu C Wikramanayake
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Cancer Control Program, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
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2
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Kang D, Cho J, Zhao D, Kim J, Kim N, Kim H, Kim S, Kim JY, Park YH, Im YH, Guallar E, Ahn JS. Scalp Cooling in Preventing Persistent Chemotherapy-Induced Alopecia: A Randomized Controlled Trial. J Clin Oncol 2024; 42:3115-3122. [PMID: 38843479 DOI: 10.1200/jco.23.02374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/04/2024] [Accepted: 04/02/2024] [Indexed: 09/07/2024] Open
Abstract
PURPOSE Current studies of the efficacy of scalp cooling are limited by short-term duration. Therefore, we conducted a randomized controlled trial to evaluate the efficacy of scalp cooling in reducing persistent chemotherapy-induced alopecia (PCIA) 6 months after chemotherapy. METHODS We conducted an open-label randomized controlled trial comparing scalp cooling versus control in newly diagnosed patients with breast cancer stages I-III scheduled to receive neoadjuvant or adjuvant chemotherapy with curative intent between December 2020 and August 2021. Patients were randomly assigned (2:1 ratio) to scalp cooling or usual clinical practice. The primary outcome was PCIA 6 months after chemotherapy. Hair thickness and density were measured using Folliscope 5.0. CIA-related distress was assessed using the CIA distress scale (CADS), with a higher score reflecting higher stress. RESULTS The proportion of patients with PCIA at 6 months was 13.5% (12/89) in the scalp-cooling group and 52.0% (26/50) in the control group. The average difference in the change in hair thickness from baseline between the scalp-cooling and control groups was 9.0 μm in favor of the intervention group. The average difference in the change in hair density between intervention and control at the end of the study was -3.3 hairs/cm2. At 6 months after chemotherapy, the average difference in the change in CADS score between the intervention and control groups was -3.2 points, reflecting reduced CIA-related stress in the intervention group. CONCLUSION Scalp cooling reduced the incidence of PCIA, primarily by increasing hair thickness compared with control. Scalp cooling is helpful in promoting qualitative hair regrowth. Yet, further research is necessary to observe longer-term benefits of scalp cooling.
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Affiliation(s)
- Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jeonghyun Kim
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nayeon Kim
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hoyoung Kim
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sooyeon Kim
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji-Yeon Kim
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yeon Hee Park
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Hyuck Im
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eliseo Guallar
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
- Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Jin Seok Ahn
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Wang W, Wang H, Long Y, Li Z, Li J. Controlling Hair Loss by Regulating Apoptosis in Hair Follicles: A Comprehensive Overview. Biomolecules 2023; 14:20. [PMID: 38254620 PMCID: PMC10813359 DOI: 10.3390/biom14010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Apoptosis is a physiological process that occurs in all cell types of the human body, and it profoundly changes the fate of hair by affecting hair follicle cells. This review outlines the cellular changes, intrinsic biochemical characteristics, and mechanisms underlying apoptosis and summarizes the hair follicle life cycle, including development, cycle stages, and corresponding cellular changes. Finally, the relationship between apoptosis and the hair cycle is discussed and the significance of apoptosis in hair loss conditions and drug treatments is highlighted. Apoptosis induces cellular changes and exhibits distinctive properties through intricate signaling pathways. Hair follicles undergo cyclic periods of growth, regression, and dormancy. Apoptosis is closely correlated with the regression phase by triggering hair follicle cell death and shedding. Regulation of apoptosis in hair follicles plays an essential role in hair loss due to maladies and drug treatments. Mitigating apoptosis can enhance hair growth and minimize hair loss. A comprehensive understanding of the correlation between apoptosis and the hair cycle can facilitate the development of novel treatments to prevent hair loss and stimulate hair regeneration.
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Affiliation(s)
- Wuji Wang
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi 563006, China; (W.W.); (H.W.); (Y.L.); (Z.L.)
- Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi 563006, China
- Department of Pharmacology, School of Pharmacy, Zunyi Medical University, Zunyi 563006, China
| | - Honglan Wang
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi 563006, China; (W.W.); (H.W.); (Y.L.); (Z.L.)
- Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi 563006, China
- Department of Pharmacology, School of Pharmacy, Zunyi Medical University, Zunyi 563006, China
| | - Yunluan Long
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi 563006, China; (W.W.); (H.W.); (Y.L.); (Z.L.)
- Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi 563006, China
- Department of Pharmacology, School of Pharmacy, Zunyi Medical University, Zunyi 563006, China
| | - Zheng Li
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi 563006, China; (W.W.); (H.W.); (Y.L.); (Z.L.)
- Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi 563006, China
- Department of Pharmacology, School of Pharmacy, Zunyi Medical University, Zunyi 563006, China
| | - Jingjie Li
- Key Laboratory of Basic Pharmacology of Ministry of Education and Joint International Research Laboratory of Ethnomedicine of Ministry of Education, Zunyi Medical University, Zunyi 563006, China; (W.W.); (H.W.); (Y.L.); (Z.L.)
- Key Laboratory of Basic Pharmacology of Guizhou Province, Zunyi Medical University, Zunyi 563006, China
- Department of Pharmacology, School of Pharmacy, Zunyi Medical University, Zunyi 563006, China
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Wu CX, Li CH, Shiao YH, Cheng HY, Wu TH, Lee CH, Chang ZY, Yeh YC. The effect of a helmet type, home-use low-level light therapy device for chemotherapy-induced alopecia: study protocol for a randomized controlled trial. Trials 2023; 24:789. [PMID: 38053197 DOI: 10.1186/s13063-023-07823-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Alopecia is one of the most common adverse effects of chemotherapy. It reduces the patient's self-esteem and quality of life and the effect of therapy. Scalp cooling is the only verified current method for prevention but success is not guaranteed, particularly after receiving anthracycline-based combinations. Low-level light therapy has been clinically proven to inhibit the progress of androgenic alopecia. A previous study using human subjects shows limited benefits for low-level light therapy for patients who suffer chemotherapy-induced alopecia but an increase in the number of probes and the optimization of light sources may improve the efficacy. This study determines the efficacy of low-level light therapy for the prevention of chemotherapy-induced hair loss for patients with breast cancer using a randomized controlled trial. METHODS One hundred six eligible breast cancer patients were randomly distributed into a low-level light therapy group and a control group, after receiving chemotherapy. Subjects in the low-level light therapy group received 12 courses of intervention within 4 weeks. Subjects in the control group received no intervention but were closely monitored. The primary outcome is measured as the difference in the hair count in a target area between the baseline and at the end of week 4, as measured using a phototrichogram (Sentra scalp analyzer). The secondary outcomes include the change in hair count at the end of week 1, week 2, and week 3 and hair width at the end of week 1, week 2, week 3, and week 4, as measured using a phototrichogram, and the change in distress, the quality of life, and self-esteem due to chemotherapy-induced alopecia, at the end of week 4, as measured using a questionnaire. DISCUSSION This study improves cancer patients' quality of life and provides clinical evidence. TRIAL REGISTRATION Registered at ClinicalTrials.gov- NCT05397457 on 1 June 2022.
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Affiliation(s)
- Cong-Xian Wu
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, 204201, Taiwan
| | - Cheng-Hsin Li
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, 204201, Taiwan
| | - Yi-Hsien Shiao
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, 204201, Taiwan
- Graduate Institute of Natural Products, Chang Gung University, Taoyuan, 333323, Taiwan
| | - Huan-Yu Cheng
- The Institute of Health Policy and Management, National Taiwan University, Taipei, 106319, Taiwan
| | - Tsung-Han Wu
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, 20401, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 33320, Taiwan
| | - Chun-Hui Lee
- Division of General Surgery, Department of Surgery, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, 204201, Taiwan
| | - Zi-Yu Chang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, 204201, Taiwan
- Institute of Traditional Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan
| | - Yuan-Chieh Yeh
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, 204201, Taiwan.
- Program in Molecular Medicine, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, 112304, Taiwan.
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5
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Mounessa J, Caravaglio JV, Domozych R, Chapman S, Dellavalle RP, Dunnick CA, Norris D. Commonly prescribed medications associated with alopecia. J Am Acad Dermatol 2023; 88:1326-1337.e2. [PMID: 37268392 DOI: 10.1016/j.jaad.2017.01.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 06/04/2023]
Abstract
BACKGROUND The diagnosis and treatment of medication-associated alopecia often challenges patients and physicians. While numerous studies on the topic exist, limited information on the strength and magnitude of these studies exists. OBJECTIVES We investigated the most commonly prescribed medications with high levels of evidence to support associations with alopecia. METHODS A list of most commonly prescribed medications was compiled using the "Top 100 Prescriptions, Sales" (Intercontinental Marketing Services) and "Top 200 Names Searched" (RxList.com). PubMed, Embase, and Web of Science were searched for "generic drug name" AND "alopecia" and "generic drug name" AND "hair loss." Two reviewers independently reviewed articles for drug, study type and level of evidence, and number of alopecia cases. RESULTS A total of 192 unique drugs were investigated, with 110 yielding positive search results. Of these, 13 were associated with alopecia in studies with strong levels of evidence (adalimumab, infliximab, budesonide, interferon β-1α, tacrolimus, enoxaparin, zoster vaccine, lamotrigine, docetaxel, capecitabine, erlotinib, imatinib, and bortezomib). LIMITATIONS Only full-length articles available in the English language were included. The methodology used relied on lists of drugs based on their sales rather than number of prescriptions, which likely overrepresented expensive drugs. CONCLUSIONS Few studies with high levels of evidence have been conducted on the topic of medication-associated alopecia. The mechanisms of hair loss must be further identified to provide effective management.
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Affiliation(s)
- Jessica Mounessa
- Stony Brook University School of Medicine, Stony Brook, New York; Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | - Renee Domozych
- University of Central Florida College of Medicine, Orlando, Florida
| | - Stephanie Chapman
- College of Human Medicine, Michigan State University, Grand Rapids, Michigan
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Cory A Dunnick
- Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado; Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - David Norris
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado; Dermatology Service, US Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, Colorado.
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6
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Rose L, Lustberg M, Ruddy KJ, Cathcart-Rake E, Loprinzi C, Dulmage B. Hair loss during and after breast cancer therapy. Support Care Cancer 2023; 31:186. [PMID: 36826602 DOI: 10.1007/s00520-023-07634-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
For patients diagnosed with breast cancer, alopecia can be a distressing side effect of treatment. Major surgeries, cytotoxic chemotherapy, and endocrine therapy may result in several different types of alopecia. This article reviews the underlying mechanisms, etiology, prevention strategies, and treatment options for chemotherapy-induced alopecia, telogen effluvium, and endocrine-induced alopecia. Here, we aim to provide breast oncologists with a review of the types of hair loss related to cancer therapy and current preventative and treatment options to facilitate informative patient counseling.
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Affiliation(s)
- Lucy Rose
- The Ohio State University College of Medicine, Columbus, OH, USA
| | | | | | | | | | - Brittany Dulmage
- Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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7
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Mitigating acute chemotherapy-associated adverse events in patients with cancer. Nat Rev Clin Oncol 2022; 19:681-697. [PMID: 36221000 DOI: 10.1038/s41571-022-00685-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/08/2022]
Abstract
Despite the enthusiasm surrounding novel targeted agents and immunotherapies, chemotherapy remains the mainstay treatment for most human malignancies, either alone or in combination. Yet, the burden of chemotherapy-associated adverse events (CAAEs) remains high and, importantly, is associated with considerable morbidity, mortality and costs that affect patients across multiple dimensions, including physical, emotional and social functioning. CAAEs can directly affect patient outcomes and indirectly increase the risk of cancer recurrence by compromising treatment intensity and continuity. Systematic efforts to identify and critically summarize the evidence on management approaches for CAAEs remain limited. Herein, we review the most common acute CAAEs having a major effect on survival, quality of life, function and/or continuation of optimal therapy. We focus on selected acute toxicities that occur during treatment, summarizing their underlying pathophysiology, multifactorial aetiologies, evidenced-based treatments, prevention strategies and management recommendations. We also summarize the available evidence on risk factors, validated risk assessment tools and other efforts to optimize symptom control in patients most likely to benefit in order to personalize the prevention and treatment of acute CAAEs. Finally, we discuss innovative symptom monitoring and supportive care interventions that are under development to further improve the outcomes of patients with cancer.
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8
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Cancer-Related Alopecia: From Etiologies to Global Management. Cancers (Basel) 2021; 13:cancers13215556. [PMID: 34771716 PMCID: PMC8583126 DOI: 10.3390/cancers13215556] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/25/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Although it does not represent a condition that threatens the life of patients, alopecia nevertheless has an essential impact on the quality of life of patients, particularly in terms of the psychological and social aspects. Indeed, while it has long been considered an acceptable side effect in the management of patients, the progressive emergence of a patient-centered approach coupled with a better knowledge of the pathophysiological processes involved has led to a better consideration of alopecia, both on the preventive and palliative sides. Thus, cancerous alopecia can be multifactorial: iatrogenic (in particular via conventional chemotherapy), induced by a vitamin/nutritional deficiency, or even caused by the disease itself. In this state-of-the-art review, we therefore cover alopecia in an exhaustive manner by considering the different mechanisms involved and their frequency as well as the various therapies offered. Abstract Alopecia represents a multifaceted challenge with distinct etiologies and consequences. Transposed to the world of oncology, different types of alopecia and molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. In patients with cancer, alopecia can be iatrogenic (i.e., due to conventional chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy and surgery) or a direct consequence of the disease itself (e.g., malnutrition, scalp metastases and paraneoplastic syndromes). Identification of the actual incriminated mechanism(s) is therefore essential in order to deliver appropriate supportive care, whether preventive or curative. On the preventive side, the last few years have seen the advent of the automated cooling cap, a prophylactic approach supported by several randomized clinical trials. On the curative side, although the treatments currently available are limited, several promising therapeutic approaches are under development. Appropriate alopecia management is essential, particularly regarding its psychological repercussions with significant consequences on the quality of life of patients and their family and with a potential impact on treatment compliance.
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Bhoyrul B, Asfour L, Lutz G, Mitchell L, Jerjen R, Sinclair RD, Holmes S, Chaudhry IH, Harries MJ. Clinicopathologic Characteristics and Response to Treatment of Persistent Chemotherapy-Induced Alopecia in Breast Cancer Survivors. JAMA Dermatol 2021; 157:1335-1342. [PMID: 34586345 DOI: 10.1001/jamadermatol.2021.3676] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Importance Alopecia induced by classic chemotherapy affects up to 65% of patients and is usually reversible. However, there are increasing reports of persistent chemotherapy-induced alopecia (pCIA), especially for patients treated with taxane-containing chemotherapy regimens. Objective To analyze the clinicopathologic characteristics and response to treatment of patients with pCIA after chemotherapy for breast cancer. Design, Setting, and Participants In this case series, a retrospective evaluation was performed of patients with a diagnosis of pCIA after chemotherapy for breast cancer in 4 specialist hair clinics from November 1, 2011, to February 29, 2020. Main Outcomes and Measures Clinical, trichoscopic, and histopathologic characteristics and treatment outcomes were analyzed. For patients who presented with diffuse alopecia or diffuse rarefaction of hair over the midfrontal scalp with widening of the central part line and preservation of the frontal hairline, the Sinclair scale (grades 1-5, where 1 indicates normal hair density and 5 indicates the most severe stage of hair loss, with little or no hair in the centroparietal region) was used to assess severity. Results One hundred patients (99 women [99%]; mean age at presentation, 54.0 years [range, 29.0-74.1 years]) were included. Most patients had diffuse nonscarring alopecia (n = 39), female pattern hair loss (n = 55), or male pattern hair loss (n = 6). Six patients developed cicatricial alopecia. Taxane-containing regimens were used for most patients (92 [92%]) and were associated with more severe alopecia than regimens that did not contain taxanes (median Sinclair grade, 4 [IQR, 3-5] vs 2 [IQR, 2-2.5]; P < .001). A total of 76 of 86 patients (88%) had trichoscopic signs indistinguishable from those of androgenetic alopecia. Of 18 patients who had biopsies, 14 had androgenetic alopecia-like features, 2 had cicatricial alopecia, and 2 had features of both. Both topical and oral minoxidil, sometimes combined with antiandrogen therapy, were associated with an improvement in hair density (median Sinclair grade, 4 [IQR, 3-5] before treatment vs 3 [IQR, 2-4] after treatment; P < .001). Conclusions and Relevance This case series outlines previously unreported features of pCIA in patients with breast cancer, including a trichoscopic description. Cosmetically significant regrowth was achieved for a significant proportion of patients with topical or systemic treatments, suggesting that pCIA may be at least partly reversible.
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Affiliation(s)
| | - Leila Asfour
- The Dermatology Centre, Salford Royal National Health Service Foundation Trust, Salford, Greater Manchester, United Kingdom
| | - Gerhard Lutz
- Hair and Nail Medicine, Bonn, Germany.,Department of Dermatology and Allergy, University Hospital of Bonn, Bonn, Germany
| | - Lorne Mitchell
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Rodney D Sinclair
- Sinclair Dermatology, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Susan Holmes
- Alan Lyell Centre for Dermatology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Iskander H Chaudhry
- Department of Histopathology, Royal Liverpool and Broadgreen University Hospitals National Health Service Trust, Liverpool, United Kingdom
| | - Matthew J Harries
- The Dermatology Centre, Salford Royal National Health Service Foundation Trust, Salford, Greater Manchester, United Kingdom.,Centre for Dermatology Research, University of Manchester, Manchester Academic Health Science Centre and National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
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10
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Piccini I, Brunken L, Chéret J, Ghatak S, Ramot Y, Alam M, Purba TS, Hardman J, Erdmann H, Jimenez F, Paus R, Bertolini M. PPARγ signaling protects hair follicle stem cells from chemotherapy-induced apoptosis and epithelial-mesenchymal transition. Br J Dermatol 2021; 186:129-141. [PMID: 34496034 DOI: 10.1111/bjd.20745] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Permanent chemotherapy-induced alopecia (pCIA), for which preventive interventions remain limited, can manifest with scarring. While the underlying pathomechanisms of pCIA are unclear, depletion of epithelial hair follicle (HF) stem cells (eHFSCs) is likely to play a role. OBJECTIVES To explore the hypothesis that eHFSCs undergo pathological epithelial-mesenchymal transition (EMT) besides apoptosis in pCIA, thus explaining the scarring phenotype. Furthermore, we tested whether a PPARγ modulator can prevent pCIA-associated pathomechanisms. METHODS Organ-cultured human scalp HFs were treated with the cyclophosphamide metabolite, 4-hydroperoxycyclophosphamide (4-HC). Additionally, HFs were pre-treated with the agnostic PPARγ modulator, N-Acetyl-GED-0507-34-Levo (NAGED), which we had previously shown to promote K15 expression and antagonize EMT in eHFSCs. RESULTS In accordance with anticipated hair bulb cytotoxicity, dystrophy and catagen induction, 4-HC promoted apoptosis along with increased p53 expression, DNA damage and pathological EMT in keratin 15+ (K15) bulge eHFSCs, as evidenced by decreased E-cadherin expression and the appearance of fibronectin- and vimentin-positive cells in the bulge. Pre-treatment with NAGED protected from 4-HC-induced hair bulb cytotoxicity/dystrophy, and halted apoptosis, p53 up-regulation, and EMT in the bulge, thereby significantly preventing the depletion of K15+ human eHFSCs ex vivo. CONCLUSIONS A cyclophosphamide metabolite alone suffices to damage and deplete human scalp eHFSCs by promoting apoptosis, DNA damage, and EMT ex vivo. Therefore, pCIA-therapeutic strategies need to target these pathological processes. Our data introduce the stimulation of PPARγ signaling as a novel intervention strategy for the prevention of pCIA, given the ability of NAGED to prevent chemotherapy-induced eHFSCs damage ex vivo.
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Affiliation(s)
- I Piccini
- Monasterium Laboratory, Münster, Germany
| | - L Brunken
- Monasterium Laboratory, Münster, Germany
| | - J Chéret
- Monasterium Laboratory, Münster, Germany.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - S Ghatak
- Monasterium Laboratory, Münster, Germany
| | - Y Ramot
- Department of Dermatology, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - M Alam
- Monasterium Laboratory, Münster, Germany.,Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain.,Dept. of Dermatology & Venereology, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Academic Health System, Doha, Qatar
| | - T S Purba
- Centre for Dermatology Research, University of Manchester, NIHR Biomedical Research Centre, Manchester, UK
| | - J Hardman
- Centre for Dermatology Research, University of Manchester, NIHR Biomedical Research Centre, Manchester, UK.,St John's Institute of Dermatology, King's College London, London, United Kingdom
| | | | - F Jimenez
- Universidad Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain.,Mediteknia Dermatology Clinic, Las Palmas de Gran Canaria, Spain
| | - R Paus
- Monasterium Laboratory, Münster, Germany.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Centre for Dermatology Research, University of Manchester, NIHR Biomedical Research Centre, Manchester, UK
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11
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[Alopecia and cancers: From basics to clinical practice]. Bull Cancer 2021; 108:963-980. [PMID: 34304865 DOI: 10.1016/j.bulcan.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/30/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022]
Abstract
Alopecia, although long considered an unavoidable consequence of cancer therapy, currently presents a multifaceted challenge. The knowledge of the physiology of the hair and consequently of the pathophysiology of alopecia has led to show that there is not one but several types of alopecia. Transposed to the world of oncology, different types of alopecia and subsequently molecular pathways have been characterized, allowing a better understanding of the underlying mechanisms. Thus, in patients with cancer, alopecia can be iatrogenic (chemotherapies, endocrine therapies, targeted therapies, immunotherapies, radiotherapy, surgery) or directly the consequence of the disease itself (malnutrition, scalp metastases, paraneoplastic syndromes). Knowledge of the incriminated mechanism(s) could thus make it possible to deploy an appropriate care component, whether on the preventive or curative sides or in terms of supportive care. These are particularly essential regarding the psychological repercussions caused by alopecia, with significant consequences on the quality of life of patients and with a potential impact on treatment compliance. On the preventive side, the last few years have seen the advent of the automated scalp cooling therapy, supported by several randomized clinical trials. On the curative side, several therapeutic proposals are currently deployed or under development in order to provide relevant treatments.
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12
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Rebora A, Guarrera M. Why Do Not All Chemotherapy Patients Lose Their Hair? Answering an Intriguing Question. Skin Appendage Disord 2021; 7:280-285. [PMID: 34307475 PMCID: PMC8280404 DOI: 10.1159/000514342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/05/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Alfredo Rebora
- Department of Dermatology, University of Genoa, Genoa, Italy
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13
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Prospective study of hair recovery after (neo)adjuvant chemotherapy with scalp cooling in Japanese breast cancer patients. Support Care Cancer 2021; 29:6119-6125. [PMID: 33797582 PMCID: PMC8410694 DOI: 10.1007/s00520-021-06168-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/18/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE Scalp cooling during chemotherapy infusion to mitigate alopecia for breast cancer patients is becoming widespread; however, studies regarding hair recovery after chemotherapy with scalp cooling are limited. We conducted a prospective study of hair recovery after chemotherapy with scalp cooling. PATIENTS AND METHODS One hundred and seventeen Japanese female breast cancer patients who completed planned (neo)adjuvant chemotherapy using the Paxman Scalp Cooling System for alopecia prevention were evaluated for alopecia prevention in our prospective study. We evaluated their hair recovery 1, 4, 7, 10, and 13 months after chemotherapy. Primary outcomes were grades of alopecia judged by two investigators (objective grades) and patients' answers to the questionnaire regarding the use of a wig or hat (subjective grades). RESULTS Of 117 patients, 75 completed scalp cooling during the planned chemotherapy cycles (Group A), but 42 discontinued it mostly after the first cycle (Group B). Objective and subjective grades were significantly better in Group A than in Group B throughout 1 year, and at 4 and 7 months after chemotherapy. When we restricted patients to those with objective Grade 3 (hair loss of > 50%) at 1 month, Group A exhibited slightly faster hair recovery based on the objective grades than Group B. There was less persistent alopecia in Group A than in Group B. CONCLUSIONS Scalp cooling during chemotherapy infusion for Japanese breast cancer patients increased the rate of hair recovery and had preventive effects against persistent alopecia.
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14
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Flores A, Choi S, Hsu YC, Lowry WE. Inhibition of pyruvate oxidation as a versatile stimulator of the hair cycle in models of alopecia. Exp Dermatol 2021; 30:448-456. [PMID: 33739490 DOI: 10.1111/exd.14307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 12/25/2022]
Abstract
Hair follicle stem cells (HFSCs) are known to be responsible for the initiation of a new hair cycle, but typically remain quiescent for very long periods. In alopecia, or hair loss disorders, follicles can be refractory to activation for years or even permanently. Alopecia can be triggered by autoimmunity, age, chemotherapeutic treatment, stress, disrupted circadian rhythm or other environmental insults. We previously showed that hair follicle stem cells and the hair cycle can be manipulated by regulation of pyruvate entry into mitochondria for subsequent oxidation to fuel the TCA cycle in normal adult mice with typical hair cycling. Here, we present new data from our efforts to develop murine models of alopecia based on environmental triggers that have been shown to do the same in human skin. We found that inhibition of pyruvate transport into mitochondria can accelerate the hair cycle even during refractory hair cycling due to age, repeated chemotherapeutic treatment and stress. Hair cycle acceleration in these alopecia models led to the formation of histologically normal hair follicles within 30-40 days of treatment without any overt signs of toxicity or deleterious effects. Therefore, we propose inhibition of pyruvate entry into mitochondria as a versatile treatment strategy for alopecia in humans.
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Affiliation(s)
- Aimee Flores
- Department of Molecular Cell and Developmental Biology, UCLA, Los Angeles, CA, USA.,Pelage Pharmaceuticals, Inc., Los Angeles, CA, USA
| | - Sekyu Choi
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
| | - Ya-Chieh Hsu
- Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
| | - William E Lowry
- Department of Molecular Cell and Developmental Biology, UCLA, Los Angeles, CA, USA.,Pelage Pharmaceuticals, Inc., Los Angeles, CA, USA.,Division of Dermatology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.,Molecular Biology Institute, UCLA, Los Angeles, CA, USA.,Broad Center for Regenerative Medicine, UCLA, Los Angeles, CA, USA
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15
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Phillips GS, Freret ME, Friedman DN, Trelles S, Kukoyi O, Freites-Martinez A, Unger RH, Disa JJ, Wexler LH, Tinkle CL, Mechalakos JG, Dusza SW, Beal K, Wolden SL, Lacouture ME. Assessment and Treatment Outcomes of Persistent Radiation-Induced Alopecia in Patients With Cancer. JAMA Dermatol 2021; 156:963-972. [PMID: 32756880 DOI: 10.1001/jamadermatol.2020.2127] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Persistent radiation-induced alopecia (pRIA) and its management have not been systematically described. Objective To characterize pRIA in patients with primary central nervous system (CNS) tumors or head and neck sarcoma. Design, Setting, and Participants A retrospective cohort study of patients from January 1, 2011, to January 30, 2019, was conducted at 2 large tertiary care hospitals and comprehensive cancer centers. Seventy-one children and adults diagnosed with primary CNS tumors or head and neck sarcomas were evaluated for pRIA. Main Outcomes and Measures The clinical and trichoscopic features, scalp radiation dose-response relationship, and response to topical minoxidil were assessed using standardized clinical photographs of the scalp, trichoscopic images, and radiotherapy treatment plans. Results Of the 71 patients included (median [range] age, 27 [4-75] years; 51 female [72%]), 64 (90%) had a CNS tumor and 7 (10%) had head and neck sarcoma. Alopecia severity was grade 1 in 40 of 70 patients (56%), with localized (29 of 54 [54%]), diffuse (13 of 54 [24%]), or mixed (12 of 54 [22%]) patterns. The median (range) estimated scalp radiation dose was 39.6 (15.1-50.0) Gy; higher dose (odds ratio [OR], 1.15; 95% CI, 1.04-1.28) and proton irradiation (OR, 5.7; 95% CI, 1.05-30.8) were associated with greater alopecia severity (P < .001), and the dose at which 50% of patients were estimated to have severe (grade 2) alopecia was 36.1 Gy (95% CI, 33.7-39.6 Gy). Predominant trichoscopic features included white patches (16 of 28 [57%]); in 15 patients, hair-shaft caliber negatively correlated with scalp dose (correlation coefficient, -0.624; P = .01). The association between hair density and scalp radiation dose was not statistically significant (-0.381; P = .16). Twenty-eight of 34 patients (82%) responded to topical minoxidil, 5% (median follow-up, 61 [interquartile range, 21-105] weeks); 4 of 25 (16%) topical minoxidil recipients with clinical images improved in severity grade. Two patients responded to hair transplantation and 1 patient responded to plastic surgical reconstruction. Conclusions and Relevance Persistent radiation-induced alopecia among patients with primary CNS tumors or head and neck sarcomas represents a dose-dependent phenomenon that has distinctive clinical and trichoscopic features. The findings of this study suggest that topical minoxidil and procedural interventions may have benefit in the treatment of pRIA.
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Affiliation(s)
- Gregory S Phillips
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Morgan E Freret
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Sabrina Trelles
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oluwaseun Kukoyi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Dermatology Service, Hospital Ruber Juan Bravo and Universidad Europea, Madrid, Spain
| | - Robin H Unger
- Department of Dermatology, Mount Sinai Medical Center, New York, New York
| | - Joseph J Disa
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Leonard H Wexler
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher L Tinkle
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James G Mechalakos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen W Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn Beal
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Suzanne L Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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16
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Chan J, Adderley H, Alameddine M, Armstrong A, Arundell D, Fox R, Harries M, Lim J, Salih Z, Tetlow C, Wong H, Thorp N. Permanent hair loss associated with taxane chemotherapy use in breast cancer: A retrospective survey at two tertiary UK cancer centres. Eur J Cancer Care (Engl) 2020; 30:e13395. [PMID: 33350015 DOI: 10.1111/ecc.13395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 09/08/2020] [Accepted: 11/27/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE Taxane chemotherapy is commonly used in the management of breast cancer. Hair loss (alopecia) is an expected side effect which may have a significant effect on quality of life. Alopecia is normally temporary but permanent chemotherapy-induced alopecia (pCIA) is increasingly recognised especially following docetaxel chemotherapy. However, the prevalence following docetaxel is not well understood and there is no published literature for paclitaxel chemotherapy. The aim of this study is to investigate the prevalence and patterns of pCIA resulting from both docetaxel and paclitaxel chemotherapy at two tertiary UK cancer centres. METHODS In collaboration between Clatterbridge Cancer Centre and The Christie NHS Foundation Trusts, a retrospective survey was conducted for breast cancer patients who had received taxane chemotherapy in the neoadjuvant and adjuvant settings. Patients who had concluded chemotherapy at least a year previously were contacted by post and invited to participate by completing a questionnaire and returning it to their treatment centre. Data collected included the incidence and pattern of pCIA using the Savin pictorial hair loss scale, and the methods used by patients to manage it. Fisher's exact test was used to compare pCIA between the docetaxel and paclitaxel cohorts. RESULTS 383 patients responded to the survey (a 63.3% overall response rate). These comprised 245 patients receiving docetaxel and 138 patients treated with paclitaxel. pCIA was reported by 23.3% of patients receiving docetaxel and 10.1% paclitaxel (p < 0.01). Overall 16.7% of patients in both groups reported the ongoing use of products or appliances such as wigs to camouflage their pCIA. In the docetaxel group, pCIA appeared to be more frequent in post-menopausal women than peri- or pre-menopausal women (37.8%, 12.3% and 19.6% respectively [Chi-square test p < 0.01]). Also in the docetaxel group, there appeared to be a trend for more severe scalp alopecia when the patient also received an aromatase inhibitor (AI) or tamoxifen and this difference was most marked in those who had received both an AI and tamoxifen as components of their treatment regime (p = 0.04). The use of scalp cooling was only recorded in the Christie paclitaxel group (n = 12). Of these 12 patients, 83.3% reported no hair loss. While overall rates of permanent eyebrow, eyelash and nostril hair loss were low, this pattern of hair loss appeared more frequent in the paclitaxel than the docetaxel group 4.3% vs. 1.8% (p = 0.29). CONCLUSIONS Both docetaxel and paclitaxel may cause permanent scalp hair loss, but it is significantly more prevalent with docetaxel compared with paclitaxel. IMPLICATIONS FOR CANCER SURVIVORS Clinicians should counsel patients regarding the risk of permanent alopecia prior to embarking upon taxane chemotherapy and routinely offer scalp cooling if available. More research is required to understand the pathobiology of this important and previously under recognised long-term side effect to enable more active preventive and management approaches.
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Affiliation(s)
- Joachim Chan
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK
| | | | - Manal Alameddine
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK
| | | | - Donna Arundell
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK
| | - Rosalyn Fox
- The Christie NHS Foundation Trust, Manchester, UK
| | - Matthew Harries
- Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Musculoskeletal and Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jonathan Lim
- The Christie NHS Foundation Trust, Manchester, UK
| | - Zena Salih
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - Helen Wong
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK
| | - Nicola Thorp
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK.,The Christie NHS Foundation Trust, Manchester, UK
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17
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Segal-Engelchin D, Shvarts S. Does Severity of Hair Loss Matter? Factors Associated with Mental Health Outcomes in Women Irradiated for Tinea Capitis in Childhood. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207388. [PMID: 33050469 PMCID: PMC7601621 DOI: 10.3390/ijerph17207388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 12/04/2022]
Abstract
Hair loss resulting from childhood irradiation for tinea capitis has been linked to mental health effects in women. However, the association of hair loss severity with mental health in this population is unknown. To address this gap, this study examined the association between hair loss severity and mental health outcomes in women irradiated for tinea capitis in childhood as well as the factors that contribute to these outcomes. Medical records, held at the archives of the Israel National Center for Compensation of Scalp Ringworm Victims, were retrospectively reviewed for 2509 women who received compensation for full or partial alopecia resulting from irradiation for tinea capitis. Mental health outcomes were determined by the number of mental health conditions reported. The results show that among women with more hair loss, risk was increased for a range of mental health problems, especially social anxiety (RR 2.44, 95% CI 2.09–2.87). Hair loss severity emerged as a significant predictor of mental health, adding to the effects of other predictors such as family, social and physical health problems (β = 0.13, 95% CI 0.27, 0.56). The effects of hair loss severity on mental health outcomes were mediated by women’s negative social experiences (indirect = 0.72, 95% bias-corrected confidence interval, 0.53–1.08). Healthcare professionals supporting women with hair loss after irradiation for childhood tinea capitis should be alert to a history of severe levels of hair loss.
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Affiliation(s)
- Dorit Segal-Engelchin
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
- Correspondence:
| | - Shifra Shvarts
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel;
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18
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Fujii T, Ichiba K, Honda C, Tokuda S, Nakazawa Y, Ogino M, Kurozumi S, Obayashi S, Yajima R, Shirabe K. Prospective observational study of chemotherapy-induced alopecia after sequential FEC + taxane and the effects of age in breast cancer patients. Breast Cancer 2020; 28:329-334. [PMID: 32944881 DOI: 10.1007/s12282-020-01161-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/11/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND Chemotherapy-induced alopecia (CIA) is a common and quite distressing adverse effects of chemotherapy. There are few detailed observational studies of CIA or of the impact of age on CIA. We performed a prospective observational study to investigate the prevalence and degree of CIA, including CIA of eyebrows, eyelashes, and body, and we examined patient's recovery from CIA, focusing on age-depending effects. METHODS We analyzed 68 female Japanese patients with breast cancer (median age 53 years, range 29-76 years) who received perioperative adjuvant chemotherapy with fluorouracil/epirubicin/cyclophosphamide (FEC) and taxane. A questionnaire was administered at the point of chemotherapy completion and 6 and 12 months after chemotherapy completion. RESULTS CIA occurred in all patients, with severe hair loss irrespective of age. CIA occurred mainly in the scalp but also in the eyebrows, eyelashes, and body for most of the patients. There were significant associations between the patient's age and the onset of hair regrowth in the eyebrows, eyelashes, and body. The onset of eyebrows, eyelash, and body hair growth were significantly shorter in the premenopausal patients. Any hair changes (e.g., thinned diameter, softer texture, curlier structure) were reported by 85.3% of the patients. CONCLUSIONS Severe CIA occurred in all 68 patients who received FEC and taxane chemotherapy. The present findings provide the first data demonstrating that age was not associated with the degree or incidence of hair loss, but age affected the recovery from CIA. These results contribute more accurate information provision and insights regarding the proper treatment of CIA.
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Affiliation(s)
- Takaaki Fujii
- Division of Breast and Endocrine Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan. .,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan.
| | - Kei Ichiba
- Nursing, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, Japan
| | - Chikako Honda
- Division of Breast and Endocrine Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
| | - Shoko Tokuda
- Division of Breast and Endocrine Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
| | - Yuko Nakazawa
- Division of Breast and Endocrine Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
| | - Misato Ogino
- Division of Breast and Endocrine Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
| | - Sasagu Kurozumi
- Division of Breast and Endocrine Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
| | - Sayaka Obayashi
- Division of Breast and Endocrine Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
| | - Reina Yajima
- Division of Breast and Endocrine Surgery, Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan.,Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma, Japan
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19
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Basmanav FB, Nöthen MM, Betz RC. Insights Into the Biology of Persistent Chemotherapy-Induced Alopecia via Genomic Approaches—An Avenue to Clinical Translation? JAMA Dermatol 2020; 156:947-948. [DOI: 10.1001/jamadermatol.2020.1866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Fitnat Buket Basmanav
- Institute of Human Genetics, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Markus M. Nöthen
- Institute of Human Genetics, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
| | - Regina C. Betz
- Institute of Human Genetics, University Hospital Bonn, Medical Faculty, University of Bonn, Bonn, Germany
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20
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Abstract
Drug reactions resulting from chemotherapy agents are common and frequently affect the skin. Although often benign, a select few of these cutaneous reactions may necessitate immediate changes to the antineoplastic regimens. Given the diversity of chemotherapeutic skin reactions and their complex implications on patient management, an organized conceptual schema is imperative for proper patient care. We evaluate a number of commonly seen chemotherapy-induced skin toxicities organized by pathogenic mechanism and drug class, providing a framework for the identification and categorization of adverse events to prevent unrecognition. Groupings of these reactions include direct cytotoxicity and/or drug accumulation, immunologic hypersensitivity, and aberrant molecular signaling.
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Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health and Science University, Portland, Oregon, USA.
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21
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Spironolactone use does not increase the risk of female breast cancer recurrence: A retrospective analysis. J Am Acad Dermatol 2020; 83:1021-1027. [PMID: 32446820 DOI: 10.1016/j.jaad.2020.05.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/08/2020] [Accepted: 05/17/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Spironolactone is used off-label for androgenic alopecia because of its ability to arrest hair loss progression and long-term safety profile. However, little is known about the safety of spironolactone in breast cancer (BC) survivors. Because spironolactone has estrogenic effects, there is a theoretical risk for BC recurrence. Given that spironolactone is an important tool in the treatment of alopecia, we investigated whether spironolactone increased risk for BC recurrence. OBJECTIVE To determine whether spironolactone is associated with increased BC recurrence. METHODS A retrospective analysis was conducted using the Humana Insurance database. Patients with a history of BC were identified using International Classification of Diseases codes, stratified by spironolactone prescription, and also matched 1:1 using propensity score analysis. Patient characteristics and cancer recurrence rates between both cohorts were compared and analyzed. RESULTS BC recurrence developed in 123 patients (16.5%) who were prescribed spironolactone compared with 3649 patients (12.8%) who developed BC recurrence without spironolactone prescribed (P = .004). After propensity matching, adjusted Cox regression analysis showed no association between spironolactone and increased BC recurrence (adjusted hazard ratio, 0.966; 95% confidence interval, 0.807-1.156; P = .953). LIMITATIONS Retrospective study. CONCLUSION Spironolactone was not independently associated with increased BC recurrence and may be considered for the treatment of alopecia in BC survivors.
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22
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Keystone Perforator Island Flap for Postmastectomy Defect Resurfacing in Late-stage Breast Cancer Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2457. [PMID: 31942283 PMCID: PMC6908361 DOI: 10.1097/gox.0000000000002457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022]
Abstract
Late-stage breast cancer usually presents with locally advanced disease, with or without metastasis. The primary tumor is typically large with skin infiltration which affects quality of life. Surgical resection will result in an extensive defect which potentially deteriorates patients’ quality of life if not properly managed. Keystone perforator island flap (KPIF) is a local advancement flap based on multiple perforators which can be a reliable reconstructive method to close an extensive defect.
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23
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Permanent chemotherapy-induced alopecia: awareness and attitudes among health care providers. Support Care Cancer 2019; 28:2887-2890. [PMID: 31745696 DOI: 10.1007/s00520-019-05169-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Reports of permanent chemotherapy-induced alopecia (PCIA) are increasing in the field of oncodermatology, but there is a dearth of information regarding how it is recognized and managed by health care providers (HCPs) across different medical specialties (dermatology, oncology, and internal medicine). METHODS A 25-question survey was designed to elicit general knowledge and awareness of PCIA, as well as attitudes about referral and treatment. Responses were collected via REDCap, a secure online application, and analyzed with descriptive statistics, chi-square, and ANOVA tests. RESULTS There was a significant difference in the number of subjects who had heard of PCIA prior to starting the survey (Derm 79%, Onc 30%, IM 22%, p < 0.05). A larger percentage of dermatology and oncology HCPs knew the correct definition of the condition (alopecia persisting > 6 months) than IM (42% and 45% vs. 17%) and significantly more had encountered patients with the condition (47% and 45% vs. 17%). More providers in dermatology and IM knew how to diagnose PCIA compared with oncology (84% and 83% vs. 70%). Dermatology HCPs were the only participants who had attempted to treat patients with PCIA, and most providers believed that patients would accept similar types of treatment for PCIA. Dermatology HCPs were more likely to report higher confidence in their abilities to diagnose and manage PCIA than other providers. CONCLUSION The results of this survey identify knowledge gaps about PCIA among health care providers. Therefore, education and multidisciplinary engagement should be pursued in order to improve awareness, diagnosis, referral, and management of PCIA as part of survivorship care.
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Purba TS, Ng'andu K, Brunken L, Smart E, Mitchell E, Hassan N, O'Brien A, Mellor C, Jackson J, Shahmalak A, Paus R. CDK4/6 inhibition mitigates stem cell damage in a novel model for taxane-induced alopecia. EMBO Mol Med 2019; 11:e11031. [PMID: 31512803 PMCID: PMC6783643 DOI: 10.15252/emmm.201911031] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 01/29/2023] Open
Abstract
Taxanes are a leading cause of severe and often permanent chemotherapy‐induced alopecia. As the underlying pathobiology of taxane chemotherapy‐induced alopecia remains poorly understood, we investigated how paclitaxel and docetaxel damage human scalp hair follicles in a clinically relevant ex vivo organ culture model. Paclitaxel and docetaxel induced massive mitotic defects and apoptosis in transit amplifying hair matrix keratinocytes and within epithelial stem/progenitor cell‐rich outer root sheath compartments, including within Keratin 15+ cell populations, thus implicating direct damage to stem/progenitor cells as an explanation for the severity and permanence of taxane chemotherapy‐induced alopecia. Moreover, by administering the CDK4/6 inhibitor palbociclib, we show that transit amplifying and stem/progenitor cells can be protected from paclitaxel cytotoxicity through G1 arrest, without premature catagen induction and additional hair follicle damage. Thus, the current study elucidates the pathobiology of taxane chemotherapy‐induced alopecia, highlights the paramount importance of epithelial stem/progenitor cell‐protective therapy in taxane‐based oncotherapy, and provides preclinical proof‐of‐principle in a healthy human (mini‐) organ that G1 arrest therapy can limit taxane‐induced tissue damage.
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Affiliation(s)
- Talveen S Purba
- Centre for Dermatology Research, School of Biological Sciences, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK
| | - Kayumba Ng'andu
- Centre for Dermatology Research, School of Biological Sciences, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK
| | - Lars Brunken
- Monasterium Laboratory - Skin & Hair Research Solutions GmbH, Münster, Germany
| | - Eleanor Smart
- Centre for Dermatology Research, School of Biological Sciences, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK
| | - Ellen Mitchell
- Centre for Dermatology Research, School of Biological Sciences, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK
| | - Nashat Hassan
- Centre for Dermatology Research, School of Biological Sciences, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK
| | - Aaron O'Brien
- Centre for Dermatology Research, School of Biological Sciences, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK
| | - Charlotte Mellor
- Centre for Dermatology Research, School of Biological Sciences, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK
| | - Jennifer Jackson
- Centre for Dermatology Research, School of Biological Sciences, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK
| | | | - Ralf Paus
- Centre for Dermatology Research, School of Biological Sciences, University of Manchester & NIHR Biomedical Research Centre, Manchester, UK.,Monasterium Laboratory - Skin & Hair Research Solutions GmbH, Münster, Germany.,Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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25
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Freites-Martinez A, Shapiro J, Chan D, Fornier M, Modi S, Gajria D, Dusza S, Goldfarb S, Lacouture ME. Endocrine Therapy-Induced Alopecia in Patients With Breast Cancer. JAMA Dermatol 2019; 154:670-675. [PMID: 29641806 DOI: 10.1001/jamadermatol.2018.0454] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Importance Endocrine therapy-induced alopecia (EIA) has been anecdotally reported but not systematically described. Objective To characterize EIA in patients with breast cancer. Design, Setting, and Participants Retrospective cohort study of 112 patients with breast cancer, diagnosed with EIA from January 1, 2009, to December 31, 2016, the patients were examined at the dermatology service in a large tertiary care hospital and comprehensive cancer center. Main Outcomes and Measures The clinical features, alopecia-related quality of life (QoL), and response to minoxidil of EIA in patients with breast cancer were assessed. Data from the Hairdex Questionnaire was used to assess the impact of the alopecia on patients QoL. Higher score indicates lower QoL (0-100 score). Efficacy of minoxidil was measured at 3 or 6 months by a single-blinded investigator through standardized clinical photographs of the scalp. Results A total of 112 female patients with breast cancer were included (median [range] age, 60 [34-90] years). A total of 104 patients (93%) had standardized clinical photographs; of these, 59 patients (53%) had trichoscopy images available at baseline, and 46 patients (41%) were assessed for response to minoxidil. Alopecia was attributed to aromatase inhibitors in 75 patients (67%) and tamoxifen in 37 (33%). Severity was grade 1 in 96 of 104 patients (92%), and the pattern was similar to androgenetic alopecia. The predominant trichoscopic feature at baseline was the presence of vellus hairs and intermediate- and thick-diameter terminal hair shafts. A negative impact on QoL was reported, with a higher effect in the emotion domain according to the Hairdex score (mean [SD], 41.8 [21.3]; P < .001). After treatment with topical minoxidil, moderate or significant improvement in alopecia was observed in 37 of 46 patients (80%). Conclusions and Relevance Endocrine therapies are associated with a pattern alopecia similar to androgenetic-type, consistent with the mechanism of action of causal agents. A significant negative impact on QoL was reported by patients, despite mostly mild alopecia severity.
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Affiliation(s)
- Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Donald Chan
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Monica Fornier
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Shanu Modi
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Devika Gajria
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Stephen Dusza
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shari Goldfarb
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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26
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Trüeb RM. Minoxidil for Endocrine Therapy-Induced Alopecia in Women With Breast Cancer-Saint Agatha's Blessing? JAMA Dermatol 2019; 154:656-658. [PMID: 29641812 DOI: 10.1001/jamadermatol.2018.0453] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ralph M Trüeb
- Center for Dermatology and Hair Diseases, University of Zurich, Zurich, Switzerland
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Kinoshita T, Nakayama T, Fukuma E, Inokuchi M, Ishiguro H, Ogo E, Kikuchi M, Jinno H, Yamazaki N, Toi M. Efficacy of Scalp Cooling in Preventing and Recovering From Chemotherapy-Induced Alopecia in Breast Cancer Patients: The HOPE Study. Front Oncol 2019; 9:733. [PMID: 31448235 PMCID: PMC6691158 DOI: 10.3389/fonc.2019.00733] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/22/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: This study aimed to assess the efficacy of scalp-cooling devices in preventing chemotherapy-induced alopecia in Japanese breast cancer patients and investigate whether a scalp-cooling device improves hair volume recovery over a 12 weeks period after completing chemotherapy. Methods: This multicenter controlled trial included women with breast cancer undergoing chemotherapy in Japan between February 2016 and March 2018. The primary endpoint was the proportion of patients with no alopecia at the end of chemotherapy. The secondary endpoint included hair volume at 12 weeks after completing chemotherapy. Results: A total of 48 patients were enrolled; of them, 34 and 14 were sequentially allocated to the scalp-cooling group using the Paxman Hair Loss Prevention System and the control group, respectively. There was no significant difference in average age between the scalp-cooling and the control groups (50.0 ± 9.6 vs. 49.0 ± 9.0 years). More than 50% of patients in each group had stage II breast cancer (scalp-cooling group: 53.1%; control group: 64.3%), more than 90% received adjuvant chemotherapy (scalp-cooling group: 96.9%; control group: 92.9%), and more than 60% were treated with a docetaxel/cyclophosphamide regimen (scalp-cooling group: 75.0%; control group: 64.3%). There were more patients judged to have no alopecia at the end of chemotherapy in the scalp-cooling group than in the control group (26.7% [8/30] vs. 0% [0/13]; P = 0.011). The proportion of patients with alopecia who experienced an increase in hair volume of ≥50% within 12 weeks duration after chemotherapy was 85.7% (24/28) in the scalp-cooling group and 50.0% (6/12) in the control group. No patient developed serious adverse events related to the scalp-cooling device. Conclusions: The use of a scalp-cooling device prevented alopecia with acceptable safety for Japanese patients. In addition, scalp cooling resulted in faster recovery of hair volume after chemotherapy, even in patients for whom scalp cooling failed to prevent chemotherapy-induced alopecia.
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Affiliation(s)
- Takayuki Kinoshita
- Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Eisuke Fukuma
- Department of Breast Surgery, Breast Center, Kameda Medical Center, Kamogawa, Japan
| | - Masafumi Inokuchi
- Department of Breast and Endocrine Surgery, Kanazawa Medical University Hospital, Kanazawa, Japan
| | - Hiroshi Ishiguro
- Department of Medical Oncology, International University of Health and Welfare Hospital, Nasushiobara, Japan
| | - Etsuyo Ogo
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Mari Kikuchi
- Department of Diagnostic Imaging, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiromitsu Jinno
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoya Yamazaki
- Department of Dermatologic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University, Kyoto, Japan
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Kang D, Kim IR, Park YH, Im YH, Zhao D, Guallar E, Ahn JS, Cho J. Impact of a topical lotion, CG428, on permanent chemotherapy-induced alopecia in breast cancer survivors: a pilot randomized double-blind controlled clinical trial (VOLUME RCT). Support Care Cancer 2019; 28:1829-1837. [DOI: 10.1007/s00520-019-04982-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 07/04/2019] [Indexed: 12/27/2022]
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29
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Stoehr JR, Choi JN, Colavincenzo M, Vanderweil S. Off-Label Use of Topical Minoxidil in Alopecia: A Review. Am J Clin Dermatol 2019; 20:237-250. [PMID: 30604379 DOI: 10.1007/s40257-018-0409-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Topical minoxidil is a well-known and often-utilized drug in dermatological practice for the treatment of alopecia. It was approved by the United States Food and Drug Administration for the treatment of androgenetic alopecia in 1988. Since its approval, minoxidil has been used off-label for the treatment of many other types of alopecia, with minimal formal evidence of efficacy. Conditions for which the use of topical minoxidil has been reported include telogen effluvium, alopecia areata (AA), scarring alopecia, eyebrow hypotrichosis, monilethrix, and chemotherapy-induced alopecia (CIA). The evidence for the use of minoxidil in each condition is derived from a variety of studies, including clinical trials, case series, and case reports. A comprehensive review of the literature indicates that while minoxidil is routinely used in the management of many alopecic conditions, there is mixed evidence for its efficacy. For certain conditions, including AA and most scarring alopecias, the evidence seems to be inconclusive. For others, such as eyebrow hypotrichosis, monilethrix, early traction alopecia, and CIA, there is more support for the efficacy of minoxidil. Although the favorable safety profile of minoxidil is established in adults, its use in the treatment of pediatric alopecia may require heightened monitoring and patient education.
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Affiliation(s)
- Jenna R Stoehr
- Department of Dermatology, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA
| | - Jennifer N Choi
- Department of Dermatology, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA
| | - Maria Colavincenzo
- Department of Dermatology, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA
| | - Stefan Vanderweil
- Department of Dermatology, Northwestern University, 676 N St Clair St, Suite 1600, Chicago, IL, 60611, USA.
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30
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Sagawa N, Ohno S, Hiratsuka T, Kondo N, Iwata H, Bando H, Ohyama T, Ishida M, Kono Y, Nakajima K, Empuku S, Nishikawa S, Irie Y, Inomata M, Kitano S. The utility of DHL-HisZnNa, a novel antioxidant, against anticancer agent-induced alopecia in breast cancer patients: a multicenter phase II clinical trial. Breast Cancer Res Treat 2019; 176:625-630. [PMID: 30806921 DOI: 10.1007/s10549-019-05164-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 02/07/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE Chemotherapy-induced alopecia (CIA) is a distressing adverse effect of anticancer drugs; however, there are currently no mechanisms to completely prevent CIA. In this study, we performed a clinical trial to examine whether sodium N-(dihydrolipoyl)-l-histidinate zinc complex (DHL-HisZnNa), an alpha-lipoic acid derivative, prevents CIA in patients with breast cancer. METHODS Between July 2014 and May 2015, we performed a multi-center, single arm, clinical trial involving 103 breast cancer patients who received adjuvant chemotherapy at three medical institutions in Japan. During chemotherapy, a lotion containing 1% DHL-HisZnNa was applied daily to the patients' scalps. The primary endpoint was the incidence of grade 2 alopecia; the secondary endpoints were the duration of grade 2 alopecia, alopecia-related symptoms, and drug-related adverse events. Alopecia was evaluated by three independent reviewers using head photographs taken from four angles. RESULTS Safety analysis was performed for 101 patients who started the protocol therapy. After excluding one patient who experienced disease progression during treatment, 100 patients who received at least two courses of chemotherapy underwent efficacy analysis. All original 101 patients developed grade 2 alopecia, the median durations of which were 119 days (112-133 days) and 203 days (196-212 days) in the groups treated with four and eight courses of chemotherapy, respectively. Mild or moderate adverse events potentially related to DHL-HisZnNa were observed in 11 patients. Alopecia-related symptoms were observed in 53 patients (52%). CONCLUSIONS The application of 1% DHL-HisZnNa to the scalp did not prevent CIA. However, this drug may promote recovery from CIA. TRIAL REGISTRATION NUMBER UMIN000014840.
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Affiliation(s)
- Noriko Sagawa
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Hasama-machi, Oita, 879-5593, Japan.
| | - Shinji Ohno
- Department of Breast Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.,Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takahiro Hiratsuka
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Hasama-machi, Oita, 879-5593, Japan
| | - Naoto Kondo
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Hiroko Bando
- Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | | | - Mayumi Ishida
- Department of Breast Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Yohei Kono
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Hasama-machi, Oita, 879-5593, Japan
| | - Kentaro Nakajima
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Hasama-machi, Oita, 879-5593, Japan
| | - Shinichiro Empuku
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Hasama-machi, Oita, 879-5593, Japan
| | | | - Yoshiko Irie
- Department of Nursing, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Hasama-machi, Oita, 879-5593, Japan
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Rozner RN, Freites-Martinez A, Shapiro J, Geer EB, Goldfarb S, Lacouture ME. Safety of 5α-reductase inhibitors and spironolactone in breast cancer patients receiving endocrine therapies. Breast Cancer Res Treat 2019; 174:15-26. [PMID: 30467659 PMCID: PMC6773272 DOI: 10.1007/s10549-018-4996-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 08/24/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To provide dermatologists and oncologists with a foundation for practical understanding and uses of 5α-reductase inhibitors and spironolactone for breast cancer patients and survivors receiving endocrine therapies (ETs), including the effect of these treatments on sex hormone levels, any reported drug interactions, and any risk of malignancy. METHODS All published studies from January 1978 through April 2018 were considered, using databases such as PubMed, Google Scholar, and Science Direct. Forty-seven studies were included in this review. RESULTS There is no evidence of interactions between 5α-reductase inhibitors and spironolactone with ETs used in breast cancer. Sex hormone alteration with 5α-reductase inhibitor or spironolactone use is variable. Three randomized controlled trials, 1 case-control study, and 6 retrospective cohort studies, including 284 female patients, studied the effects of 5α-reductase inhibitors on serum estrogen levels. Levels were increased in 97 of 284 (34%) patients, decreased in 15 of 284 (5.3%) patients, and unchanged in 162 of 284 (57%) patients. Four retrospective cohort studies, 1 case study, and 1 double-blinded crossover study, including 95 female patients, assessed the effect of spironolactone on estrogen levels. Levels were increased in 25 of 95 (26%) patients, decreased in 6 of 95 (6.3%) patients, and unchanged in 64 of 95 (67%) patients. Ultimately, most patients did not have a significant alteration in the level of estrogen when using 5α-reductase inhibitors or spironolactone. No consistent evidence of increased risk of female breast cancer while on spironolactone was reported in 3 studies including 49,298 patients; the risk of breast cancer with the use of 5α-reductase inhibitors has not been studied. CONCLUSIONS Most patients did not show increased estrogen levels with spironolactone and there were no data suggesting increased risk of breast cancer. Based on hormonal and pharmacological activity, spironolactone may be considered for further research on alopecia and hirsutism in breast cancer patients.
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Affiliation(s)
- Raquel N Rozner
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 16 East 60th Street, Suite 407, 4th Floor, New York, NY, 10022, USA
| | - Azael Freites-Martinez
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 16 East 60th Street, Suite 407, 4th Floor, New York, NY, 10022, USA
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA
| | - Eliza B Geer
- Multidisciplinary Pituitary and Skull Base Tumor Center, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Shari Goldfarb
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Mario E Lacouture
- Department of Dermatology, Memorial Sloan-Kettering Cancer Center, 16 East 60th Street, Suite 407, 4th Floor, New York, NY, 10022, USA.
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A multicenter survey of temporal changes in chemotherapy-induced hair loss in breast cancer patients. PLoS One 2019; 14:e0208118. [PMID: 30625139 PMCID: PMC6326423 DOI: 10.1371/journal.pone.0208118] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/12/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose Many breast cancer patients suffer from chemotherapy-induced hair loss. Accurate information about temporal changes in chemotherapy-induced hair loss is important for supporting patients scheduled to receive chemotherapy, because it helps them to prepare. However, accurate information, on issues such as the frequency of hair loss after chemotherapy, when regrowth starts, the condition of regrown hair, and the frequency of incomplete hair regrowth, is lacking. This study aimed to clarify the long-term temporal changes in chemotherapy-induced hair loss using patient-reported outcomes for chemotherapy-induced hair loss. Methods We conducted a multicenter, cross-sectional questionnaire survey. Disease-free patients who had completed adjuvant chemotherapy consisting of anthracycline and/or taxanes for breast cancer within the prior 5 years were enrolled from 47 hospitals and clinics in Japan. Descriptive statistics were obtained in this study. The study is reported according to the STROBE criteria. Results The response rate was 81.5% (1511/1853), yielding 1478 questionnaires. Hair loss occurred in 99.9% of patients. The mean time from chemotherapy until hair loss was 18.0 days. Regrowth of scalp hair occurred in 98% of patients. The mean time from the completion of chemotherapy to the beginning of regrowth was 3.3 months. Two years after chemotherapy completion, the scalp-hair recovery rate was <30% in approximately 4% of patients, and this rate showed no improvement 5 years after chemotherapy. Eighty-four percent of the patients initially used wigs, decreasing to 47% by 1 year after chemotherapy and 15.2% after 2 years. The mean period of wig use was 12.5 months. However, a few patients were still using wigs 5 years after completing chemotherapy. Conclusions Our survey focused on chemotherapy-induced hair loss in breast cancer patients. We believe these results to be useful for patients scheduled to receive chemotherapy.
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Abstract
The interaction between hair and malignancy is complicated. Various hair abnormalities can manifest in oncology patients as a clinical manifestation, the result of cancer therapy, or due to a paraneoplastic condition. The mechanisms of these changes remain unclear. Alopecia is one of the common clinical presentations occurring in oncology patients that affects their quality of life. The condition can concomitantly develop during the course of malignancy or when patients undergo cancer treatment. It is important for physicians to understand alopecia in association with malignancy as it may be an important associated finding or provide the clues to aid diagnosis. The aim of this review is to summarize the clinical characteristics of alopecia that occur in cancer patients and their relationship with the type of malignancy and its treatment.
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Kang D, Kim IR, Choi EK, Im YH, Park YH, Ahn JS, Lee JE, Nam SJ, Lee HK, Park JH, Lee DY, Lacouture ME, Guallar E, Cho J. Permanent Chemotherapy-Induced Alopecia in Patients with Breast Cancer: A 3-Year Prospective Cohort Study. Oncologist 2018; 24:414-420. [PMID: 30120165 PMCID: PMC6519756 DOI: 10.1634/theoncologist.2018-0184] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 06/14/2018] [Indexed: 01/28/2023] Open
Abstract
Chemotherapy‐induced alopecia is (CIA) considered temporary; however, some patients report persistent alopecia several years after chemotherapy. Long‐term prospective data on the incidence and impact of permanent CIA is scarce. This article reports the results of a study conducted to estimate the long‐term incidence of persistent CIA in a cohort of breast cancer patients with measurements of hair volume and density before and after chemotherapy. Background. Although chemotherapy‐induced alopecia (CIA) is considered temporary, some patients report persistent alopecia several years after chemotherapy. There is, however, a paucity of long‐term prospective data on the incidence and impact of permanent CIA (PCIA). The objective of our study was to estimate the long‐term incidence of PCIA in a cohort of patients with breast cancer whose hair volume and density were measured prior to chemotherapy and who were followed for 3 years after chemotherapy. Materials and Methods. Prospective cohort study of consecutive patients ≥18 years of age with postoperative diagnosis of stage I–III breast cancer expected to receive adjuvant chemotherapy at the outpatient breast cancer clinic at the Samsung Medical Center in Seoul, Korea, from February 2012 to July 2013 (n = 61). Objective hair density and thickness were measured using a noninvasive bioengineering device. Results. The proportion of participants who had PCIA at 6 months and 3 years was 39.5% and 42.3%, respectively. PCIA was characterized in most patients by incomplete hair regrowth. Patients who received a taxane‐based regimen were more likely to experience PCIA compared with patients with other types of chemotherapy. At a 3‐year follow‐up, hair thinning was the most common problem reported by study participants (75.0%), followed by reduced hair volume (53.9%), hair loss (34.6%), and gray hair (34.6%). Conclusion. PCIA is a common adverse event of breast cancer adjuvant cytotoxic chemotherapy. Clinicians should be aware of this distressing adverse event and develop supportive care strategies to counsel patients and minimize its impact on quality of life. Implications for Practice. Knowledge of permanent chemotherapy‐induced alopecia, an under‐reported adverse event, should lead to optimized pretherapy counseling, anticipatory coping techniques, and potential therapeutic strategies for this sequela of treatment.
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Affiliation(s)
- Danbee Kang
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
- Center for Clinical Epidemiology, Samsung Comprehensive Cancer Center, Seoul, Korea
| | - Im-Ryung Kim
- Cancer Education Center, Samsung Comprehensive Cancer Center, Seoul, Korea
| | - Eun-Kyung Choi
- Cancer Education Center, Samsung Comprehensive Cancer Center, Seoul, Korea
| | - Young Hyuck Im
- Department of Hematology/Oncology, Samsung Comprehensive Cancer Center, Seoul, Korea
| | - Yeon Hee Park
- Department of Hematology/Oncology, Samsung Comprehensive Cancer Center, Seoul, Korea
| | - Jin Seok Ahn
- Department of Hematology/Oncology, Samsung Comprehensive Cancer Center, Seoul, Korea
| | - Jeong Eon Lee
- Department of Surgery, Samsung Comprehensive Cancer Center, Seoul, Korea
| | - Seok Jin Nam
- Department of Surgery, Samsung Comprehensive Cancer Center, Seoul, Korea
| | | | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Eliseo Guallar
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
- Center for Clinical Epidemiology, Samsung Comprehensive Cancer Center, Seoul, Korea
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
- Center for Clinical Epidemiology, Samsung Comprehensive Cancer Center, Seoul, Korea
- Cancer Education Center, Samsung Comprehensive Cancer Center, Seoul, Korea
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Mustoe MM, Lee CM, Melisko ME, Esserman LJ, Rugo HS. The DigniCap Scalp Cooling System and its use in the treatment of chemotherapy-induced alopecia. Future Oncol 2018; 14:2461-2469. [PMID: 30001151 DOI: 10.2217/fon-2018-0178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Chemotherapy-induced alopecia remains an emotionally traumatic side effect for cancer patients that impacts the quality of life, may be protracted in duration and may influence treatment decisions. Scalp cooling has been shown to be effective in preventing chemotherapy-induced alopecia. The DigniCap Scalp Cooling System is designed to prevent hair loss by cooling the scalp to reduce the impact of chemotherapy on hair follicle cells. Recent studies have shown the safety, efficacy and low-grade toxicity of the DigniCap System with a 66.3% success rate in hair preservation (n = 106) relative to 0% in a nonrandomized control group according to a prospective pivotal study. Data also support improved quality of life in several domains. Two scalp cooling devices including the DigniCap are now US FDA cleared and can be offered as a part of standard of care.
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Affiliation(s)
- Mollie M Mustoe
- Helen Diller Family Comprehensive Center, University of California, San Francisco, CA 94115, USA
| | - Carmen M Lee
- Helen Diller Family Comprehensive Center, University of California, San Francisco, CA 94115, USA
| | - Michelle E Melisko
- Helen Diller Family Comprehensive Center, University of California, San Francisco, CA 94115, USA
| | - Laura J Esserman
- Helen Diller Family Comprehensive Center, University of California, San Francisco, CA 94115, USA
| | - Hope S Rugo
- Helen Diller Family Comprehensive Center, University of California, San Francisco, CA 94115, USA
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Martín M, de la Torre-Montero JC, López-Tarruella S, Pinilla K, Casado A, Fernandez S, Jerez Y, Puente J, Palomero I, González Del Val R, Del Monte-Millan M, Massarrah T, Vila C, García-Paredes B, García-Sáenz JA, Lluch A. Persistent major alopecia following adjuvant docetaxel for breast cancer: incidence, characteristics, and prevention with scalp cooling. Breast Cancer Res Treat 2018; 171:627-634. [PMID: 29923063 PMCID: PMC6133184 DOI: 10.1007/s10549-018-4855-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/13/2018] [Indexed: 11/29/2022]
Abstract
Background Persistent alopecia (PA) after docetaxel has been recently described. The aim of our study is to establish the incidence and characteristics of PA following adjuvant docetaxel for breast cancer (BC) and to test the ability of scalp cooling in prevention. Patients and methods BC patients receiving adjuvant chemotherapy followed or not by endocrine therapy (and a control group receiving only endocrine therapy) were interviewed in a single institution at 1.5 to 5 years following primary diagnosis searching for PA. A confirmatory prevalence study was later performed in other two institutions. Finally, a prevention study using prophylactic scalp cooling (PSC) with ELASTO-GEL hypothermia caps in patients receiving adjuvant docetaxel was performed. Results In the initial prevalence study (492 patients), minor forms of PA (grade 1) were recorded with all chemotherapy regimens and aromatase inhibitors. Patients receiving docetaxel regimens at cumulative dose (CD) ≥ 400 mmg/m2 presented a significantly higher prevalence of grades 1 PA (33–52%) and 2 PA (5–12%). Prevalence of grade 2 PA with docetaxel CD ≥ 400 mmg/m2 was confirmed in two other institutions. Overall, grade 2 PA was seen in 10.06% (95% CI 7.36–13.61) of 358 patients with docetaxel regimens reaching CD ≥ 400 mmg/m2, but not in patients with lower docetaxel CD, other chemotherapy regimens, or endocrine therapy alone. In prevention trial, no grade 2 PA occurred among 116 patients receiving adjuvant docetaxel (≥ 400 mmg/m2) and PSC followed-up after a 96 months median time. PSC was well tolerated. No scalp relapses were seen among 30 patients (22% of all inclusions) having disease relapse. Conclusion Adjuvant treatment with docetaxel (CD ≥ 400 mmg/m2) is associated with a significant rate of grade 2 PA, leading to wearing a wig, in around 10% of patients. This toxicity was completely prevented with scalp cooling. Clinical Trial Reference: NCT00515762. Electronic supplementary material The online version of this article (10.1007/s10549-018-4855-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Martín
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain. .,Hospital General Universitario Gregorio Marañón, Medical Oncology Service, Calle Maiquez, no. 9, 28007, Madrid, Spain.
| | - J C de la Torre-Montero
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain.,Universidad Pontificia Comillas, Madrid, Spain
| | - S López-Tarruella
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - K Pinilla
- Medical Oncology Department, Hospital Clínico Universitario, CIBERONC, Valencia, Spain
| | - A Casado
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - S Fernandez
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain.,Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - Y Jerez
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - J Puente
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - I Palomero
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - R González Del Val
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - M Del Monte-Millan
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - T Massarrah
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, Madrid, Spain
| | - C Vila
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - B García-Paredes
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - J A García-Sáenz
- Medical Oncology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - A Lluch
- Medical Oncology Department, Hospital Clínico Universitario, CIBERONC, Valencia, Spain
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Manier KK, Rowe LS, Welsh J, Armstrong TS. The impact and incidence of altered body image in patients with head and neck tumors: a systematic review. Neurooncol Pract 2018; 5:204-213. [PMID: 31386002 DOI: 10.1093/nop/npy018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Body image dissatisfaction is a common issue among patients with cancer and is associated with difficulty coping, anxiety, and depression. Patients with tumors involving the head and neck are at increased risk of body image dissatisfaction due to the visible disfigurement that can occur from their illness and its treatment. Patients with primary central nervous system (CNS) malignancies often face similar tumor-related and treatment-related effects, yet there is limited research conducted in this population. Our aim was to perform a systematic review of the literature on body image in patients with tumors of the head and neck, and identify factors associated with body image alterations during treatment, with the intention of applying these approaches to those with CNS disease. A systematic search of PubMed and EMBASE was performed using predefined criteria. Nine studies met the inclusion criteria and were selected for review. The literature collected showed a relationship between body image and age, depressive symptoms, and tumor grade or stage. In addition, body image disturbance had an impact on patients' daily functioning and psychosocial indices including anxiety, coping, and body reintegration. Evaluation of the impact of body image alterations in patients with CNS tumors is needed to direct clinical care, explore research opportunities, and improve patient quality of life.
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Affiliation(s)
- Karra K Manier
- Neuro-Oncology Branch, National Cancer Institute Building, Room, Bethesda, MD
| | - Lindsay S Rowe
- Center for Cancer Research National Cancer Institute Building CRC, Room Bethesda, MD
| | - Judith Welsh
- NIH Library, National Institutes of Health, Building, Room, Bethesda, MD
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute Building, Room, Bethesda, MD
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Freites-Martinez A, Shapiro J, van den Hurk C, Goldfarb S, Jimenez JJ, Rossi AM, Paus R, Lacouture ME. Hair disorders in cancer survivors. J Am Acad Dermatol 2018; 80:1199-1213. [PMID: 29660423 DOI: 10.1016/j.jaad.2018.03.056] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/06/2018] [Accepted: 03/11/2018] [Indexed: 12/19/2022]
Abstract
With increasing survival rates across all cancers, survivors represent a growing population that is frequently affected by persistent or permanent hair growth disorders as a result of systemic therapies, radiotherapy, surgical procedures, and therapeutic transplants. These hair disorders include persistent chemotherapy-induced alopecia, persistent radiotherapy-induced alopecia, endocrine therapy-induced alopecia and hirsutism, postsurgery alopecia and localized hypertrichosis, and persistent stem cell transplantation and targeted therapy-induced alopecia. The information contained in this continuing medical education series should facilitate a better understanding on hair disorders in cancer survivors so that adequate support and therapies may be provided.
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Affiliation(s)
- Azael Freites-Martinez
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jerry Shapiro
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Corina van den Hurk
- Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| | - Shari Goldfarb
- Breast Cancer Medicine Service, Department of Medicine, Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joaquin J Jimenez
- Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Anthony M Rossi
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ralf Paus
- Dermatology Research Centre, University of Manchester, and the National Institute of Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom; National Institute of Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
| | - Mario E Lacouture
- Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
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Abstract
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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40
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Fonia A, Cota C, Setterfield JF, Goldberg LJ, Fenton DA, Stefanato CM. Permanent alopecia in patients with breast cancer after taxane chemotherapy and adjuvant hormonal therapy: Clinicopathologic findings in a cohort of 10 patients. J Am Acad Dermatol 2017; 76:948-957. [DOI: 10.1016/j.jaad.2016.12.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 12/13/2016] [Accepted: 12/15/2016] [Indexed: 12/18/2022]
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Zdenkowski N, Tesson S, Lombard J, Lovell M, Hayes S, Francis PA, Dhillon HM, Boyle FM. Supportive care of women with breast cancer: key concerns and practical solutions. Med J Aust 2017; 205:471-475. [PMID: 27852186 DOI: 10.5694/mja16.00947] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients diagnosed with breast cancer may have supportive care needs for many years after diagnosis. High quality multidisciplinary care can help address these needs and reduce the physical and psychological effects of breast cancer and its treatment. Ovarian suppression and extended endocrine therapy benefits are associated with vasomotor, musculoskeletal, sexual and bone density-related side effects. Aromatase inhibitor musculoskeletal syndrome is a common reason for treatment discontinuation. Treatment strategies include education, exercise, simple analgesia and a change to tamoxifen or another aromatase inhibitor. Chemotherapy-induced alopecia may be a constant reminder of breast cancer to the patient, family, friends, acquaintances and even strangers. Alopecia can be prevented in some patients using scalp-cooling technology applied at the time of chemotherapy infusion. The adverse impact of breast cancer diagnosis and treatment on sexual wellbeing is under-reported. Identification of physical and psychological impacts is needed for implementation of treatment strategies. Fear of cancer recurrence reduces quality of life and increases distress, with subsequent impact on role functioning. Identification and multidisciplinary management are key, with referral to psychosocial services recommended where indicated. The benefits of exercise include reduced fatigue, better mental health and reduced musculoskeletal symptoms, and may also include reduced incidence of breast cancer recurrence. Identification and management of unmet supportive care needs are key aspects of breast cancer care, to maximise quality of life and minimise breast cancer recurrence.
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Affiliation(s)
| | | | | | | | - Sandra Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD
| | | | - Haryana M Dhillon
- Centre for Medical Psychology and Evidence-based Decision-making, University of Sydney, Sydney, NSW
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Chemotherapy-induced irreversible alopecia in early breast cancer patients. Breast Cancer Res Treat 2017; 163:527-533. [PMID: 28324267 DOI: 10.1007/s10549-017-4204-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this work is to determine the prevalence of chemotherapy-induced irreversible alopecia (CIIA), which is defined as an alopecia that exists at least 6 months after completion of chemotherapy and factors affecting CIIA in early breast cancer patients. METHODS We performed a cross-sectional study. We retrospectively identified breast cancer patients who had received AC (Adriamycin, Cyclophosphamide) or AC-T (AC followed by Taxane) as neoadjuvant or adjuvant chemotherapy. We conducted questionnaire survey regarding alopecia and measured hair density using phototrichogram. RESULTS From February 2015 to May 2015, among 265 patients who responded properly to the questionnaire, the women who answered they had severe alopecia (alopecia > 50% of scalp) were 19 patients (7.2%). AC-only and AC-T treated patients reported severe alopecia in 2.7% and 10.5%, respectively, which were significantly different (p < 0.001). Mean hair density was 75 hair/cm2 (range 42-112) and 75.2/cm2 (range 48.3-102) on occipital area and vertex area, respectively. Hair loss was the most frequent in parietal area (42.6%). Half of total patients (46%) and 73% of CIIA patients regarded that their hair became thinner after chemotherapy CONCLUSIONS: We found that significant proportion of early breast cancer patients were suffering from severe CIIA, especially when they had been treated with AC followed by taxane regimen.
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Distress and body image due to altered appearance in posttreatment and active treatment of breast cancer patients and in general population controls. Palliat Support Care 2017; 16:137-145. [DOI: 10.1017/s1478951517000062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:Our objective was to evaluate long-term altered appearance, distress, and body image in posttreatment breast cancer patients and compare them with those of patients undergoing active treatment and with general population controls.Method:We conducted a cross-sectional survey between May and December of 2010. We studied 138 breast cancer patients undergoing active treatment and 128 posttreatment patients from 23 Korean hospitals and 315 age- and area-matched subjects drawn from the general population. Breast, hair, and skin changes, distress, and body image were assessed using visual analogue scales and the EORTC BR–23. Average levels of distress were compared across groups, and linear regression was utilized to identify the factors associated with body image.Results:Compared to active-treatment patients, posttreatment patients reported similar breast changes (6.6 vs. 6.2), hair loss (7.7 vs. 6.7), and skin changes (5.8 vs. 5.4), and both groups had significantly more severe changes than those of the general population controls (p < 0.01). For a similar level of altered appearance, however, breast cancer patients experienced significantly higher levels of distress than the general population. In multivariate analysis, patients with high altered appearance distress reported significantly poorer body image (–20.7, CI95% = –28.3 to –13.1) than patients with low distress.Significance of results:Posttreatment breast cancer patients experienced similar levels of altered appearance, distress, and body-image disturbance relative to patients undergoing active treatment but significantly higher distress and poorer body image than members of the general population. Healthcare professionals should acknowledge the possible long-term effects of altered appearance among breast cancer survivors and help them to manage the associated distress and psychological consequences.
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Yoon JS, Choi M, Shin CY, Paik SH, Kim KH, Kwon O. Development of a Model for Chemotherapy-Induced Alopecia: Profiling of Histological Changes in Human Hair Follicles after Chemotherapy. J Invest Dermatol 2016; 136:584-92. [PMID: 26774950 DOI: 10.1038/jid.2015.358] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 11/10/2022]
Abstract
Optimized research models are required to further understand the pathogenesis and prophylaxis of chemotherapy-induced alopecia. Our aim was to develop a mouse model for chemotherapy-induced alopecia by follicular unit transplantation of human hair follicles onto immunodeficient mice. Twenty-two weeks after transplantation, a single dose of cyclophosphamide (Cph) was administered to mice in the Cph100 (100 mg/kg) and Cph150 (150 mg/kg) groups. On day 6, hair follicles showed dystrophic changes, with swollen dermal papilla and ectopic melanin clumping in the hair bulb. In addition, upregulated expression of apoptotic regulators [P53, Fas/Fas-ligand, tumor necrosis factor-related apoptosis-inducing ligand/tumor necrosis factor-related apoptosis-inducing ligand receptor (TRAIL/TRAIL receptor), and Bax], increased apoptotic matrix keratinocytes, downregulated Ki67 expression, and decreased melanogenic protein in the hair bulb were noted in both groups. After 12 treatment days, hair follicles in Cph100 mice appeared to diminish dystrophic changes. In contrast, hair follicles of Cph150 mice prematurely entered a dystrophic catagen phase after 9 treatment days, and immunofluorescence staining for Ki67 and melanogenic protein expressions was barely visible. Two hair follicle damage response pathways were observed in this model, namely dystrophic anagen (Cph100) and catagen (Cph150) pathways. Our model might be useful for further understanding the impact of chemotherapy on human hair follicles.
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Affiliation(s)
- Ji-Seon Yoon
- Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University College of Medicine, Seoul, Korea
| | - Mira Choi
- Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University College of Medicine, Seoul, Korea; Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Chang Yup Shin
- Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hwan Paik
- Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University College of Medicine, Seoul, Korea; Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Han Kim
- Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University College of Medicine, Seoul, Korea; Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
| | - Ohsang Kwon
- Laboratory of Cutaneous Aging and Hair Research, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea; Institute of Human-Environment Interface Biology, Seoul National University College of Medicine, Seoul, Korea; Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.
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Martín M, Ruiz Simón A, Ruiz Borrego M, Ribelles N, Rodríguez-Lescure Á, Muñoz-Mateu M, González S, Margelí Vila M, Barnadas A, Ramos M, Del Barco Berron S, Jara C, Calvo L, Martínez-Jáñez N, Mendiola Fernández C, Rodríguez CA, Martínez de Dueñas E, Andrés R, Plazaola A, de la Haba-Rodríguez J, López-Vega JM, Adrover E, Ballesteros AI, Santaballa A, Sánchez-Rovira P, Baena-Cañada JM, Casas M, del Carmen Cámara M, Carrasco EM, Lluch A. Epirubicin Plus Cyclophosphamide Followed by Docetaxel Versus Epirubicin Plus Docetaxel Followed by Capecitabine As Adjuvant Therapy for Node-Positive Early Breast Cancer: Results From the GEICAM/2003-10 Study. J Clin Oncol 2015; 33:3788-95. [PMID: 26416999 DOI: 10.1200/jco.2015.61.9510] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Capecitabine is an active drug in metastatic breast cancer (BC). GEICAM/2003-10 is an adjuvant trial to investigate the integration of capecitabine into a regimen of epirubicin and docetaxel for node-positive early BC. PATIENTS AND METHODS Patients with operable node-positive BC (T1-3/N1-3) were eligible. After surgery, 1,384 patients were randomly assigned to receive epirubicin plus cyclophosphamide (EC; 90 and 600 mg/m(2), respectively, × four cycles), followed by docetaxel (100 mg/m(2) × four cycles; EC-T) or epirubicin plus docetaxel (ET; 90 and 75 mg/m(2), respectively, × four cycles), followed by capecitabine (1,250 mg/m(2) twice a day on days 1 to 14, × four cycles; ET-X); all regimens were given every 3 weeks. The primary end point was invasive disease-free survival. Secondary end points included safety (with an alopecia-specific study) and overall survival (OS). RESULTS After a median follow-up of 6.6 years and 297 events, 86% of patients who received EC-T and 82% of those who received ET-X were invasive disease free at 5 years (hazard ratio, 1.30; 95% CI, 1.03 to 1.64; log-rank P = .03). The OS difference between arms was not statistically significant (hazard ratio, 1.13; 95% CI, 0.82 to 1.55; log-rank P = .46). The most frequent grade 3 to 4 adverse events in the EC-T versus ET-X arms were neutropenia (19% v 10%), with 7% febrile neutropenia across arms; fatigue (13% v 11%); diarrhea (3% v 11%); hand-foot syndrome (2% v 20%); mucositis (6% v 5%); vomiting (both, 5%); and myalgia (4.5% v 1%). Incomplete scalp hair recovery was more frequent in the EC-T than ET-X arm (30% v 14%), and patients who received EC-T wore wigs significantly longer than those who received ET-X (8.35 v 6.03 months). CONCLUSION Invasive disease-free survival, but not OS, was significantly superior for patients with node-positive early BC who received the adjuvant standard schedule EC-T than for those who received the experimental ET-X regimen. Toxicity profiles differed substantially across arms.
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Affiliation(s)
- Miguel Martín
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain.
| | - Amparo Ruiz Simón
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Manuel Ruiz Borrego
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Nuria Ribelles
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Álvaro Rodríguez-Lescure
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Montserrat Muñoz-Mateu
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Sonia González
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Mireia Margelí Vila
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Agustí Barnadas
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Manuel Ramos
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Sonia Del Barco Berron
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Carlos Jara
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Lourdes Calvo
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Noelia Martínez-Jáñez
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - César Mendiola Fernández
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - César A Rodríguez
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Eduardo Martínez de Dueñas
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Raquel Andrés
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Arrate Plazaola
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Juan de la Haba-Rodríguez
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Jose Manuel López-Vega
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Encarna Adrover
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ana Isabel Ballesteros
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ana Santaballa
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Pedro Sánchez-Rovira
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - José M Baena-Cañada
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Maribel Casas
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - María del Carmen Cámara
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Eva Maria Carrasco
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Ana Lluch
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Carlos Jara, Fundación Hospitalaria de Alcorcón; Noelia Martínez-Jáñez, Hospital Universitario Ramón y Cajal; César Mendiola Fernández, Hospital Universitario; Ana Isabel Ballesteros, Hospital de la Princesa; Maribel Casas, María del Carmen Cámara, and Eva Carrasco, GEICAM Headquarters, Madrid; Amparo Ruiz Simón, Instituto Valenciano de Oncología; Ana Santaballa, Hospital Universitario La Fe; Ana Lluch, Hospital Clínico Universitario de Valencia-INCLIVA-Universidad de Valencia, Valencia; Manuel Ruiz Borrego, Hospital Universitario Virgen del Rocío, Sevilla; Nuria Ribelles, Hospital Universitario Virgen de la Victoria IBIMA, Málaga; Álvaro Rodríguez-Lescure, Hospital General de Elche; Encarna Adrover, Hospital Clínico Universitario de Alicante, Alicante; Montserrat Muñoz-Mateu, Hospital Clinic i Provincial; Sonia González, Hospital Mutua de Terrassa; Mireia Margelí Vila, Hospital Universitario Germans Trias i Pujol; Agustí Barnadas, Universitat Autònoma de Barcelona, Barcelona; Manuel Ramos, Centro Oncológico de Galicia; Lourdes Calvo, Complejo Hospitalario Universitario A Coruña, A Coruã; Sonia Del Barco Berron, Instituto Catalán de Oncología, Girona; César A. Rodríguez, Hospital Universitario de Salamanca, Salamanca, Spain; Eduardo Martínez de Dueñas, Hospital Provincial de Castellón, Castellón; Raquel Andrés, Hospital Universitario Lozano Blesa, Zaragoza; Arrate Plazaola, Onkologikoa, San Sebastián; Juan de la Haba-Rodríguez, Universidad de Córdoba, Córdoba; Jose Manuel López-Vega, Hospital Universitario Marqués de Valdecilla, Santander; Pedro Sánchez-Rovira, Complejo Hospitalario de Jaén, Jaén; and José M. Baena-Cañada, Hospital Universitario Puerta del Mar, Cádiz, Spain
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Champagne C, Taylor M, Farrant P. Permanent chemotherapy-induced nonscarring alopecia and premature ovarian failure. Clin Exp Dermatol 2015; 40:589-90. [DOI: 10.1111/ced.12596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- C. Champagne
- Department of Dermatology; Churchill Hospital; Oxford University Hospitals NHS Trust; Oxford UK
| | - M. Taylor
- Department of Cellular Pathology; Brighton and Sussex University Hospitals; Brighton UK
| | - P. Farrant
- Department of Dermatology; Brighton and Sussex University Hospitals; Brighton UK
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van den Hurk CJG, Winstanley J, Young A, Boyle F. Measurement of chemotherapy-induced alopecia-time to change. Support Care Cancer 2015; 23:1197-9. [PMID: 25663579 DOI: 10.1007/s00520-015-2647-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
Data on chemotherapy-induced alopecia (CIA) as a side effect of cancer treatment are scarce. CIA is given minimal attention in clinical trials and in the literature. However, when asking the patients with cancer for their opinion, CIA appears to have a major impact, particularly on body image and quality of life. Currently, there is no commonly used measure to evaluate CIA; It is time to improve the management and measurement of CIA.
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Affiliation(s)
- C J G van den Hurk
- Netherlands Comprehensive Cancer Organisation, Eindhoven, The Netherlands,
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Kanti V, Nuwayhid R, Lindner J, Hillmann K, Stroux A, Bangemann N, Kleine-Tebbe A, Blume-Peytavi U, Garcia Bartels N. Analysis of quantitative changes in hair growth during treatment with chemotherapy or tamoxifen in patients with breast cancer: a cohort study. Br J Dermatol 2014; 170:643-50. [DOI: 10.1111/bjd.12716] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2013] [Indexed: 12/11/2022]
Affiliation(s)
- V. Kanti
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - R. Nuwayhid
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - J. Lindner
- Department of Gynecology and Obstetrics; Ostalb-Hospital; Aalen Germany
| | - K. Hillmann
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - A. Stroux
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité - Universitätsmedizin Berlin; Berlin Germany
- Department of Medical Statistics and Clinical Epidemiology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - N. Bangemann
- Interdisciplinary Breast Center; Charité - Universitätsmedizin Berlin; Berlin Germany
| | | | - U. Blume-Peytavi
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - N. Garcia Bartels
- Department of Dermatology and Allergy; Clinical Research Center for Hair and Skin Science; Charité - Universitätsmedizin Berlin; Berlin Germany
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Choi M, Kim MS, Park SY, Park GH, Jo SJ, Cho KH, Lee JW, Park KD, Shin HY, Kang HJ, Kwon O. Clinical characteristics of chemotherapy-induced alopecia in childhood. J Am Acad Dermatol 2014; 70:499-505. [DOI: 10.1016/j.jaad.2013.10.034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/14/2013] [Accepted: 10/16/2013] [Indexed: 11/28/2022]
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Herskovitz I, Tosti A. Female pattern hair loss. Int J Endocrinol Metab 2013; 11:e9860. [PMID: 24719635 PMCID: PMC3968982 DOI: 10.5812/ijem.9860] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 04/24/2013] [Accepted: 05/05/2013] [Indexed: 12/19/2022] Open
Abstract
CONTEXT Female pattern hair loss (FPHL) also known as female androgenetic alopecia is a common condition afflicting millions of women that can be cosmetically disrupting. Prompt diagnosis and treatment are essential for obtaining optimal outcome. This review addresses the clinical presentation of female pattern hair loss, its differential diagnosis and treatment modalities. EVIDENCE ACQUISITION A) Diffuse thinning of the crown region with preservation of the frontal hairline (Ludwig's type) B) The "Christmas tree pattern" where the thinning is wider in the frontal scalp giving the alopecic area a triangular shaped figure resembling a christmas tree. C) Thinning associated with bitemporal recession (Hamilton type). Generally, FPHL is not associated with elevated androgens. Less commonly females with FPHL may have other skin or general signs of hyperandrogenism such as hirsutism, acne, irregular menses, infertility, galactorrhea and insulin resistance. The most common endocrinological abnormality associated with FPHL is polycystic ovarian syndrome (PCOS). RESULTS The most important diseases to consider in the differential diagnosis of FPHL include Chronic Telogen Effluvium (CTE), Permanent Alopecia after Chemotherapy (PAC), Alopecia Areata Incognito (AAI) and Frontal Fibrosing Alopecia (FFA). This review describes criteria for distinguishing these conditions from FPHL. CONCLUSIONS The only approved treatment for FPHL, which is 2% topical Minoxidil, should be applied at the dosage of 1ml twice day for a minimum period of 12 months. This review will discuss off-label alternative modalities of treatment including 5-alfa reductase inhibitors, antiandrogens, estrogens, prostaglandin analogs, lasers, light treatments and hair transplantation.
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Affiliation(s)
- Ingrid Herskovitz
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, USA
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, USA
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