Permanent Chemotherapy Induced Alopecia (PCIA)

By: Armand DeSollar and Sarah Saint

Chemotherapy induced alopecia• Many chemotherapy drugs can cause hair loss• The incidence rate of alopecia due to chemotherapy is around 65% • The exact mechanism by which chemotherapy causes alopecia is still up for

debate• However, one hypothesis is that the toxins in the chemotherapy destroy the

hair follicle, which is the site of hair growth• Most of the time, hair growth will continue once the chemotherapy is stopped• But, the incident rate for permanent hair loss after chemotherapy is around

3%

Treatment of chemotherapy inducedalopecia

1. 2% Topical Minoxidil: is the pharmacologic intervention that has shown the most promise in regrowing hair after chemotherapy

• In a double-blind randomized trial of 22 participants, 2% minoxidil shortened the amount of time it took hair to regrow by 50.2 days compare to the control group

2. 1,25-dihydroxyVitamin D: has shown promise in regrowing hair in murine models• Did cause dermatitis on the applied spot

3. AS101: significantly reduced CIA in humans and provided complete protection in animals4. Scalp cooling: early data shows it has success rates around 50%, but it is only for the prevention of alopecia and does not treat hair loss after chemotherapy

Hair Cycle3 Stages• Anagen Phase (Growing stage) -

Lasts 2-6 years and determines hair length

• Catagen (Transition stage) - Lasts about 1 to 2 weeks; hair is cut off from blood supply and from cells that produce new hair

• Telogen (Resting phase) - Lasts 3-4 months. Old hair is “resting” and not growing.

Permanent chemotherapy induced alopecia (PCIA)• PCIA is the absence of or incomplete hair regrowth lasting longer than 6

months after chemotherapy• Exact reason for PCIA is still being debated• Researchers believe PCIA occurs due to permanent damage to the stem cells

in the hair bulge but it could occur due to interference with active signaling pathways that trigger hair growth.

• Hair follicles of individuals with PCIA histologically have similar characteristics• The majority show a reduction in anagen (growing) phase hair follicles,

increase in telogen (resting) phase hair follicles, and miniaturization of hair follicles.

Treatments for PCIA• Lose Dose Oral Minoxidil

– Case report of 39 year old woman treated with cytotoxic chemotherapy drugs (cyclophosphamide and busulfan) for myeloid leukemia.

– She was clinically diagnosed with PCIA and was 16 months out from treatment with little to no hair regrowth.

– Histologically, she had an increase in telogen (resting) phase hair follicles and miniaturization of hair follicles.

– Treatment: Took 1 mg of oral minoxidil daily for one year.

Treatments for PCIAResults for low dose oral minoxidil:

• She regrew significant amounts of hair after one year which continued into the second year of treatment

• Histologically, she had an increased number of anagen (growing) phase hair follicles, a decrease in telogen (resting) phase hair follicles, and reversal of follicle miniaturization.

Treatments for PCIA• 5% Topical Minoxidil

–Case Report # 1• 58 year old female treated with taxane

chemotherapy (docetaxel) for breast cancer. No hair regrowth after 7 years.

• Applied 5% topical minoxidil twice daily to scalp. • Results: Increase volume of persisting hair, but no

response to rest of scalp after 6 months.

Treatments for PCIA• 5% Topical Minoxidil

–Case Report #2• 55 year old woman treated with taxane chemotherapy

(pacitaxel) for breast cancer. No significant hair regrowth after 3 years.

• Applied 5% topical minoxidil twice daily for 6 months.• Results: Increased volume of persisting hair, but no

response for the rest of the scalp

Treatments for PCIA• AS101

– An immunomodulator: ammonium trichloro[dioxoethylene-O,O’)tellurate

– 3 case reports for a 26, 18, and 11 year old treated with cytotoxic chemotherapy for medulloblastoma. All have incomplete or no hair growth 1-2 years after treatment

– All 3 individuals applied a .01% spray form of AS101 to their scalps once daily for 3 months

Treatments for PCIA• AS101 Results:

–11 year old- Mild hair regrowth; less than 25% of hair coverage

–18 year old- Moderate hair regrowth; 25%-50% of hair coverage

–26 year old- Significant hair regrowth; More than 50% of hair coverage

Treatments for PCIA• CG428

– Botanical spray containing a blend of citrus, onion, cocoa, and guarana.

– Researchers believe CG428 may reduce inflammation in the scalp, improve hair regrowth, and restore the natural hair cycle.

– 21 subjects suffering from persistent hair issues after chemotherapy enrolled in a study to look at the effectiveness of CG428

Treatments for PCIA• CG428

–All study participants used the topical spray twice per day.

–First improvement was observed:• In 33% of participants after 1 month• In 52% of participants after 2 months• In 76% of participants after 3 months

CG428

Treatments for PCIA• Bimatoprost

– Has not been studied for scalp hair loss– Mainly used for eyelash loss due to

chemotherapy, but not permanent eyelash loss due to chemotherapy

– Studies show that .03% topical bimatoprost solution resulted in quicker eyelash regrowth compared to normal eyelash regrowth following chemotherapy

Treatments for PCIA• Micro-Needling

–Uses a motorized pen with a needle at the end to superficially penetrate skin to stimulate collagen and elastin production and encourage skin to regenerate.

–Inject platelet-rich plasma into patients’ scalps to kick start growth

–Not proven, but may have potential

Support Group• Aheadofourtime.org

– “world-wide organization of cancer patients who have banded together to share emotional support, compare medical research and educate our health care providers. If you are tired of the stares and the dismissive suggestions to “wear a wig”, you will find understanding and, indeed, empowerment among us”

ReferencesAhluwalia, G. S. (2013). Safety and Efficacy of Bimatoprost Solution 0.03% Topical Application in Patients with Chemotherapy-Induced Eyelash Loss. Journal of Investigative Dermatology Symposium Proceedings, 16(1). CG428. (2014). Retrieved April 04, 2016, from http://cg428.com/ Kluger, N., Jacot, W., Frouin, E., Rigau, V., Poujol, S., Dereure, O., Guillot, B., Romieu, G., Bessis, D. (2012). Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel: A prospective study of 20 patients. Annals of Oncology, 23(11), 2879-2884. Retrieved March 25, 2016, from http://annonc.oxfordjournals.org/content/23/11/2879.long Miteva, M., Misciali, C., Fanti, P. A., Vincenzi, C., Romanelli, P., & Tosti, A. (2011). Permanent Alopecia After Systemic Chemotherapy: A Clinicopathological Study of 10 Cases. The American Journal of Dermatopathology, 33(4), 345-350. Morris, C., Woodward, J., & Stinnett, S. (2011). The role of bimatoprost eyelash gel in chemotherapy-induced madarosis: An analysis of efficacy and safety. Int J Trichol International Journal of Trichology, 3(2), 84. Retrieved March 25, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250027/ Payne, A. S. (2015, February 4). Chemotherapy-induced alopecia. Retrieved March 25, 2016, from http://www.uptodate.com/contents/chemotherapy-induced-alopecia Prevezas, C., Matard, B., Pinquier, L., & Reygagne, P. (2009). Irreversible and severe alopecia following docetaxel or paclitaxel cytotoxic therapy for breast cancer. British Journal of Dermatology, 160(4), 883-885. Retrieved April 1, 2016, from http://www.academia.edu/17545181/Irreversible_and_severe_alopecia_following_docetaxel_or_paclitaxel_cytotoxic_therapy_for_breast_cancer Tallon, B., Blanchard, E., & Goldberg, L. J. (2010). Permanent chemotherapy-induced alopecia: Case report and review of the literature. Journal of the American Academy of Dermatology, 63(2), 333-336. Retrieved March 31, 2016, from https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0190962209008238 Yang, X., & Thai, K. (2015). Treatment of permanent chemotherapy-induced alopecia with low dose oral minoxidil. Australasian Journal of Dermatology. Yeager, C. E., & Olsen, E. A. (2011). Treatment of chemotherapy-induced alopecia. Dermatologic Therapy, 24(4), 432-442.