Combination of Topical and Oral Minoxidil Proves better than Topical Alone in Cancer Treatment Related Hair Loss

Topical PLUS Oral Minoxidil Proves better than Topical Alone in Cancer Treatment Related Hair Loss

Authors from South Korea set out to assess the efficacy of LDOM in patients with breast cancer diagnosed with persistent chemotherapy induced alopecia (CIA) and/or endocrine therapy induced alopecia (EIA).

Permanent chemotherapy-induced alopecia (pCIA) is the absence of hair regrowth after more than 6 months of treatment discontinuation. Endocrine therapy induced alopecia refers to hair loss that follows use of aromatase inhibitors and selective estrogen receptor modulators (SERMS). These agents have shown benefits in the adjuvant and therapeutic setting for premenopausal or postmenopausal women with early-stage or advanced breast cancer

Combined pCIA and EIA was defined as incomplete hair regrowth 6 months after chemotherapy completion with alopecia aggravation post-initiation of endocrine therapy.

There were 20 patients in the study with PCIA, 69 with EIA, 11 with combined PCIA and EIA. In 95% of patients with PCIA, taxane drugs were the cause. In EIA, SERMS was the cause in 68.1% of patients and aromatase inhibitors in31.9%. The appearance of hair loss differed in the two groups. In patients with hair loss from EIA, the hair loss was mainly and androgenetic alopecia-like pattern in 97%. In contrast, in hair loss due to PCIA, the hair loss was AGA-like in 60 % and diffuse in 40 %.

Minoxidil use in Patients with PCIA and EIA

Treatment outcomes were evaluated in 56 patients with sufficient follow-up.

There were 19 patients treated with topical minoxidil alone and 37 treated with topical minoxidil and LDOM. Concomitant treatment with 1.25 to 5.0 mg daily LDOM and once daily 5% topical minoxidil solution demonstrated better outcome than 5% minoxidil alone. 13.5% of patients in the combo group had complete response compared to 0 % in the topical minoxidil alone group. 78.4 % had partial response compared to 52.6 % in the topical alone group. These differences were statistically significant. Hair density increased 6.4 % in the minoxidil alone group and 15.7% in the combo group and this was statistically significant (p=0.003)

Side Effects

Typical side effects were experienced in the 2 groups. Hypertrichosis was present in 13.5% of combo patients and periorbital edema in  5 %. 1 patient with periorbital edema actually withdrew due to edema.

Summary and Discussion

There is still some debate as to whether adding topical minoxidil to a solid plan that involves oral minoxidil is really worthwhile or not. A study by Klein and colleagues in androgenetic alopecia suggested that patients using low dose oral minoxidil had similar outcomes compared to patients using the combination of LDOM and topical minoxidil. So in this South Korean study by King and colleagues, we really don’t know if oral minoxidil ALONE would have the same outcome as topical and oral minoxidil TOGETHER. The Klein et al study suggests that it just might, and perhaps ORAL MINOXIDIL USERS are wasting time and money using topical minoxidil. More studies are needed to figure out if indeed that’s always true.

Here we have evidence that the combination is better than topical. We don’t have a good sense of exactly what the doses were and what proportion used 5 mg and what proportion used 1.25 mg. It could be that a higher proportion were using 2.5 and above.  The study is different than the Klein et al study in that patients here were female and in the Klein study 60 % were female and 40 % were male and there was an ORAL ALONE group in the Klein et al study but not the King et al study.

Nevertheless, the data here suggest that combination therapy may be worthwhile in patients with breast cancer.

REFERENCE

Kang J et al. Efficacy of low-dose oral minoxidil in the management of anticancer therapy-induced alopecia in patients with breast cancer: A retrospective cohort study. J Am Acad Dermatol 2022 Dec 13;S0190-9622(22)03261-3.

Klein E et al. Comparing combination low-dose oral minoxidil and topical minoxidil with oral minoxidil alone for the treatment of non-scarring alopecia; a retrospective chart review. J Cosmet Dermatol. 2022 Jun 1