Azael Freites-Martinez1, Jerry Shapiro2, Donald Chan1, Monica Fornier3,4, Shanu Modi3,4, Devika Gajria3,4, Stephen Dusza1, Shari Goldfarb3,4, Mario E Lacouture1. 1. Dermatology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York. 2. The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York. 3. Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York. 4. Department of Medicine, Weill Cornell Medical College, New York, New York.
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.
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.
Authors: C Davies; J Godwin; R Gray; M Clarke; D Cutter; S Darby; P McGale; H C Pan; C Taylor; Y C Wang; M Dowsett; J Ingle; R Peto Journal: Lancet Date: 2011-07-28 Impact factor: 79.321
Authors: Raquel N Rozner; Azael Freites-Martinez; Jerry Shapiro; Eliza B Geer; Shari Goldfarb; Mario E Lacouture Journal: Breast Cancer Res Treat Date: 2018-11-22 Impact factor: 4.872
Authors: Azael Freites-Martinez; Jerry Shapiro; Corina van den Hurk; Shari Goldfarb; Joaquin J Jimenez; Anthony M Rossi; Ralf Paus; Mario E Lacouture Journal: J Am Acad Dermatol Date: 2018-04-14 Impact factor: 11.527
Authors: Gregory S Phillips; Morgan E Freret; Danielle Novetsky Friedman; Sabrina Trelles; Oluwaseun Kukoyi; Azael Freites-Martinez; Robin H Unger; Joseph J Disa; Leonard H Wexler; Christopher L Tinkle; James G Mechalakos; Stephen W Dusza; Kathryn Beal; Suzanne L Wolden; Mario E Lacouture Journal: JAMA Dermatol Date: 2020-09-01 Impact factor: 10.282
Authors: Martina Silvestri; Antonio Cristaudo; Aldo Morrone; Claudia Messina; Luigi Bennardo; Steven Paul Nisticò; Maria Mariano; Norma Cameli Journal: Drug Saf Date: 2021-05-06 Impact factor: 5.606