Preventing chemotherapy induced hair loss - new options around the corner

Preventing chemotherapy induced hair loss 

60 % of patients receiving chemotherapy lose their hair and most grow back hair within  6 months. I've evaluated dozens and dozens of patients in the last year who didn't grow their hair back completely after chemotherapy treatment. This phenomenon is called  "permanent chemotherapy induced alopecia" (PCIA). We have also successfully performed hair transplants on a number of patients with PCIA moving hair from thicker areas to thinner areas. Today, I want to discuss the topic of both chemotherapy induced hair loss and permanent chemotherapy hair loss and introduce the concept of "scalp cooling" which may soon be granted FDA approval as a treatment.

Chemotherapy Induced Hair Loss

60 % of cancer patients develop hair loss after chemotherapy. Massive shedding beginning 1-3 weeks after chemotherapy. The hair loss is generally complete at 1-2 months and hair growth occurs 3-6 months later. Hair loss from chemotherapy is extremely distressing. Studies have shown that 47 % of female cancer patients consider hair loss as the most traumatic aspect of treatment and 8 % would decline chemotherapy on account of the possibility of developing hair loss.

Does hair always grow back after chemotherapy?

Recently, it has been shown that not all patients regrow their hair after chemotherapy. Some medications such as taxanes (for breast cancer), busulfan (for blood cancers) and cisplatin (for many cancers) may be associated with some patients not growing all their hair back. This is called permanent chemotherapy induced alopecia (PCIA). I explored this in a previous blog. 

Can hair loss be prevented from chemotherapy?

Certain drugs such as minoxidil can shorter the duration that the hair loss lasts and reduce the severity of the hair loss. Other drugs are being explored, including a drug called AS101. Scalp cooling (also called scalp hypothermia) is a new treatment option that is being explored. Cooling the scalp reduces the amount of chemotherapy to the scalp and has been shown in 6 of 7 studies to reduce hair loss. The technique is used in Canada (by some hospitals) and Europe but not in the USA. It is currently undergoing study in the US and may be approved in the USA in the near future. Check out the links to read more. The two scalp cooling agents to be on the lookout for are the Penguin Cold Cap and Dignicap.

Comment :

Hair loss from chemotherapy is extremely distressing. Scalp cooling offers a new option to reduce the chances of hair loss and I'm really interested to see how these studies make out in the US.  Really good studies are being done and may lead to their approval soon if these US studies show them safe and effective.  It will be important to determine if scalp cooling reduces the chance of PCIA - permanent chemotherapy hair loss. It's very distressing to patients when the hair doesn't return to its original density after cancer treatments are done. We are seeing more and more women with PCIA in our Toronto office and sometimes hair restoration is an option but sometimes there is too little hair density to make it a good option.  Scalp cooling may help prevent not only chemotherapy hair loss but reduce PCIA as well.  

Jeff Donovan MD

Reference

1. McGarvey et al 2001         2. Mundstedt  et al 1997    3. Batchelor et al 2001