Cancer-Related Alopecia: From Etiologies to Global Management
Abstract
:Simple Summary
Abstract
1. Introduction
2. Cancer-Related Alopecia: Mechanisms and Epidemiology
2.1. Classification and Diagnosis
2.2. Chemotherapy
2.3. Focus on Persistent CIA (pCIA)
2.4. Targeted Therapies (TTs)
2.5. Endocrine Therapies (ETs)
2.6. Radiotherapy (RT)
2.7. Immunotherapy
2.8. Other Mechanisms
3. Alopecia Management
3.1. ANIA Prevention
3.2. ANIA Treatments
3.3. Palliative Care and Supplementary Management
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Treatment Type | Clinical Topography | Main Incriminated Mechanism(s) | Time to Onset | Reversibility | Frequency (%) and Range ([]) |
---|---|---|---|---|---|
Chemotherapies | Diffuse and +/− total | Cell division blockage and apoptosis Destruction of the follicle | 2–3 weeks from start | Average: 3–6 months post-treatment Irreversible (with certain regimens) | ≈65 [<10–100] |
Endocrine therapies | Hair thinning AGA-like pattern | Miniaturization of the follicle | 1–91 months | Not systematic | ≈5 [0–25] |
Targeted therapies | Very variable (target dependent) | Miniaturization of the follicle (+/− destruction) | Very variable | Possible even during treatment Irreversible with some molecules | ≈15 [2–60] |
Radiotherapy (<43 Gy) | Depending on the radiation field | Destruction of the follicle | 1–3 weeks from start | Average: 2–4 months post-irradiation | ≈75–100 |
Radiotherapy (≥43 Gy) | Depending on the radiation field | Destruction of the follicle | ≈100 weeks | No (scaring alopecia) | ≈75–100 |
Immunotherapies | Variable | Cycle blockage and dysimmunity | Variable | Variable | ≈1–2 |
Clinical Aspect | Absent | Slight | Moderate | Severe | Total | ||
---|---|---|---|---|---|---|---|
SALT hair loss (%) | 0 | 1–24 | 25–49 | 50–74 | 75–95 | 96–99 | 100 |
Olsen grades | 0 | 1 | 2 | 3 | 4a | 4b | 5 |
CTCAE v5.0 grades | 0 | 1 | 2 |
Molecule (Class) | All-Grade Estimated Frequency (%) |
---|---|
Daunorubicin, doxorubicin, epirubicin (TI2) | ≈80–100 |
Docetaxel, paclitaxel (taxanes) | |
High-dose cyclophosphamide (AA) | |
Etoposide, Idarubicin (TI2) | ≈40–60 |
Intravenous topotecan, irinotecan (TI1) | |
Bleomycin (CA) | ≈10–30 |
Vinblastine, vincristine, vinorelbine (PA) | |
5-Fluorouracil, gemcitabine, methotrexate (AM) | |
Capecitabine (AM) | <10 |
Carboplatin, cisplatin, oxaliplatin (PS) |
Molecule (Class) | All-Grade Estimated Frequency (%) |
---|---|
SMOi (vismodegib specifically) | 60 |
Mul-I (e.g., sorafenib, regorafenib) | 25–30 |
BRAFi (e.g., dabrafenib, vemurafenib) | 20–25 |
EGFRi (e.g., afatinib, erlotinib) | 5–15 |
VEGFRi (e.g., axitinib, cabozantinib, pazopanib, sunitinib) | |
Anti-VEGF (bevacizumab) | |
Anti-EGFR (e.g., cetuximab) | |
ALKi (e.g., crizotinib) | |
MEKi (e.g., trametinib) |
Molecule (Class) | All-Grade Estimated Frequency (%) |
---|---|
All types of endocrine therapies | ≃5% |
All types of endocrine therapies * | ≃10% |
Letrozole (AI) + ribociclib (CDK4/6i) | ≃33% |
Anastrozole (AI) + gosereline (aGnRH) | ≃25% |
Letrozole (AI) + palbociclib (CDK4/6i) | ≃22% |
Fulvestrant (AE) + palbociclib (CDK4/6i) | ≃15% |
Tamoxifen (SERM) then anastrozole (AI) | ≃15% |
Tamoxifen (SERM) | ≃10% |
Leuproreline (aGnRH) | ≃10% |
Exemestane (AI) + aminoglutethimide | ≃10% |
AI + fulvestrant (AE) | ≃8% |
Fulvestrant (AE) | ≃2% |
Anastrozole, letrozole, exemestane (AI) | ≃2% |
Flutamide, bicalutamide, nilutamide, abiraterone, enzalutamide (ADT) | ≤1% |
Type of Alopecia | Recommendation(s) | Level of Evidence |
---|---|---|
Global approaches |
| |
CIA |
| II IV |
pCIA |
| IV IV |
EIA |
| III IV |
RIA |
| IV |
pRIA |
| IV IV |
IIA |
| IV |
TIA |
| IV IV |
Eyebrows/Lashes |
| III |
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Quesada, S.; Guichard, A.; Fiteni, F. Cancer-Related Alopecia: From Etiologies to Global Management. Cancers 2021, 13, 5556. https://doi.org/10.3390/cancers13215556
Quesada S, Guichard A, Fiteni F. Cancer-Related Alopecia: From Etiologies to Global Management. Cancers. 2021; 13(21):5556. https://doi.org/10.3390/cancers13215556
Chicago/Turabian StyleQuesada, Stanislas, Alexandre Guichard, and Frédéric Fiteni. 2021. "Cancer-Related Alopecia: From Etiologies to Global Management" Cancers 13, no. 21: 5556. https://doi.org/10.3390/cancers13215556