Endocrine Therapy-Induced Alopecia (EIA) Mario E Lacouture MD Member, Memorial Hospital Director, Oncodermatology Program New York, NY
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1 Endocrine Therapy-Induced Alopecia (EIA) Mario E Lacouture MD Member, Memorial Hospital Director, Oncodermatology Program New York, NY
2 Disclosures Research funding Berg, BMS, Genentech/Roche, RJR Fund, Galderma, Paxman,Novartis Consulting/Advisory Legacy, Novartis, Janssen, BMS, Genentech/Roche, Galderma, Debio, Pfizer, Helsinn, Silk Therapeutics, Foamix, Boehringer Ingelheim, Medische Voet
3 Endocrine Therapy in Breast Cancer Ali and Coombes, Nat Rev Cancer 2002
4 Puglisi et al, Ann Intern Med 2001; Rossi et al, Ann Onc 2013
5 Yip et al, Br J Dermatol 2009, 2012
6 Hormones and Hair-Dangerous Liasions Ohnemus et al, Endocrine Rev 2006; Brough, Int J Womens Derm 2017
7 Endocrine Therapy-Induced Alopecia (EIA) Hairs after AI/ Tamoxifen Saggar et al, Oncologist 2013; Hillman et al, Br J Dermatol 2012; Galliccio et al, Br Cancer Res Treat 2013; Rossi et al, Ann Onc 2013
8 Estrogen (not Testosterone) is Good for Hair Estradiol + Spironolactone Adenuga et al, JAAD 2012
9 Endocrine Therapy-Induced Alopecia (EIA) SERMs, Aromatase inhibitors Meta analysis (n=13,145): 4.4% Survey (n=868): 31.8% Tamoxifen 1 yr Anastrozole 3yrs Saggar et al, Oncologist 2013; Park et al, Ann Dermatol 2014; Galliccio et al, Br Cancer Res Treat 2013; Lindner et al, Br J Dermatol 2012
10 CHANCE: A Prospective, Longitudinal Study of Chemotherapy- Induced Hair, Skin And Nail Changes in Women with Breast Cancer That I will permanently lose my hair from chemotherapy or with hormones? Primary endpoint: Incidence/severity of permanent CIA or HTIA Therapy Init Eval Eval Eval Eval Eval Study end Global alopecia Yr 0 Yr 1 Yr 2 Yr 3 ClinicalTrials.gov Identifier: NCT
11 CHANCE: A Prospective, Longitudinal Study of Chemotherapy- Induced Hair, Skin And Nail Changes in Women with Breast Cancer That I will permanently lose my hair from chemotherapy or with hormones? Primary endpoint: Incidence/severity of permanent CIA or HTIA Therapy Init Eval Eval Eval Eval Eval Study end Yr 0 Yr 1 Yr 2 Yr 3 Hair number/diameter ClinicalTrials.gov Identifier: NCT
12 CHANCE study (Data cutoff December 2017) Alopecia Tamoxifen cohort N=21 (%)* Aromatase inhibitor cohort N= 20 (%) CTCAE v4.03 Baseline Follow-up Baseline Follow-up Grade 0 (no alopecia) 14 (66.7) 6 (28.6) 11 (55) 8 (40) Grade 1 (<50% of hair loss) 7 (33.3) 15 (71.4) 7 (35) 11 (55) Grade 2 (>50% of hair loss) (5) 1 (5) Trichoscopy data Baseline Follow-up Baseline Follow-up Hair shaft N per cm2 199 (36.51) (33.49) (45) (51.9) Hair thickness (microns) 70 (10) 70 (10) 70 (10) 70 (10) Lacouture et al, ASCO Annual Meeting 2018
13 CHANCE study (Data cutoff December 2017) Skin disorders a year after follow-up Tamoxifen cohort N=21 (%) Eyelash alopecia (any grade) 3 (14.3) 2 (10) Eyebrow alopecia (any grade) 2 (9.5) 2 (10) Aromatase inhibitor cohort N= 20 (%) Nail disorders* Tamoxifen cohort N=17 (%) Aromatase inhibitor cohort N= 16 (%) Nail discoloration (Grade 1) 6 (35.3) 7 (43.8) Nail ridging 8 (47) 10 (62.5) Nail loss 0 (0) 0 (0) Paronychia 0 (0) 0 (0) Lacouture et al, ASCO Annual Meeting 2018
14 Time to alopecia development (n=72) Months on therapy * ECDF: empirical cumulative distribution function Freites-Martinez et al, JAMA Dermatol 2018
15 Quality of Life n=52 Hair Shaft Diameter (n=82) Freites-Martinez et al, JAMA Dermatol 2018
16 Post-Chemotherapy Alopecia: pcia or EIAC Baseline characteristics pcia No. (%) (n = 98) EIAC No. (%) (n = 94) P Median age 56.5 (18-83 years) 56 (29-84 years).90 Phenotype Pattern alopecia (Androgenetic alopecia-like pattern) 44 (59) 69 (75).04 Diffuse alopecia 31 (41) 23 (25) Alopecia severity by CTCAE v4.0 Grade 1 46 (61) 80 (87) <.001 Grade 2 29 (39) 12 (13) Eyebrow/eyelashes alopecia 28 (37) 26 (28).25 Trichoscopy characteristics No. (SD) (n = 45) (46) No. (SD) (n = 62) (66) Hair shaft diameter (microns) Hair density (per cm 2 ) 104 (48) 116 (35).14 Mean hair per follicular unit <.001 Freites-Martinez et al (unpublished data)
17 Post-Chemotherapy Alopecia: pcia or EIAC 50 * Normalized Hairdex score (possible range: 0-100) Emotions Self-confidence Functioning Stigmatization Symptoms pcia (n = 41) EIAC (n = 58) pcia Mean EIAC Mean Freites-Martinez et al (unpublished data)
18 Post-Chemotherapy Alopecia: pcia or EIAC pcia EIAC
19 Alopecia Management Minoxidil 2% Finasteride 2.5mg Won et al, Dermatol Ther 2017; Brough, Int J Womens Derm 2017
20 Androgen Inhibition for Alopecia Finasteride 2.5mg 24 weeks Won et al, Dermatol Ther 2018
21 Alopecia Management Algorithm Brough, Int J Womens Derm 2017
22 Tamoxifen, 39 y/o Tamoxifen + Minoxidil Freites-Martinez et al, JAMA Dermatol 2018
23 Anastrozole, 72 y/o Anastrozole + Minoxidil+ Spironolactone Freites-Martinez et al, 2017 et al, JAMA Dermatol 2018
24 ETAL Management-Clinical Outcome Letrozole, 66 y/o Letrozole + Minoxidil Freites-Martinez et al, JAMA Dermatol 2018
25 60% Minoxidil 5% (n=46) 50% 50% 40% 30% 26% 24% 20% 10% 0% No Improvement Moderate Improvement Significant Improvement Freites-Martinez et al, JAMA Dermatol 2018
26 Anastrozole, 72 y/o Anastrozole + Minoxidil+ Spironolactone Follicles: 28 HS diameter (avg): 82 Follicles: 35 HS diameter (avg): 89 Freites-Martinez et al, JAMA Dermatol 2018
27 120 P<0.05 Patients on AI/Tam (n=41) Density (number of hairs) P< Diameter (Microns) Baseline Follow-up Difference Terminal hair density Vellus hair density Hair shaft diameter -20 Freites-Martinez et al, JAMA Dermatol 2018
28 Endocrine Therapy-Induced Alopecia (EIA): Conclusions Endocrine therapies frequently result in alopecia Impact on QoL significant Severity usually is grade 1 (mild) and responds to minoxidil and spironolactone EIA will increase in importance Longer adjuvant therapy and increased survival Decreased incidence of CIA with novel therapies Trials for EIA
29 Thank you
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