Abstract
Endocrine therapy-induced hair loss (ETIHL) associated with aromatase inhibitors and tamoxifen treatment is currently mostly reported but remained an unresolved therapeutic issue in patients with breast cancer (BC) since the number of studies regarding the management is limited in literature. Herein we investigated the possible causes of this clinical problem and its relation with endocrine therapies widely used for BC survivors and made some modest practical recommendations in light of the literature review in order to provide an optimal management. On the basis of literature findings, common causes of hair loss apart from endocrine therapies should be investigated with an initial evaluation workup and then should be corrected, if observed. Treatment with topical 5-alpha reductase inhibitors and supplementation of Vitamin C and omega-3 fatty acids are likely appeared to be the most appropriate treatment agents for ETIHL without causing an adverse effect on BC prognosis. However, more prospective, randomised, placebo-controlled studied are required in order to confirm our results and also identify the clinical effects of this problem on patients with BC.
Highlights
Tamoxifen and Aromatase Inhibitors (AIs) currently hold an important place as endocrine therapy (ET) in adjuvant and/or metastatic setting of the patients with Hormone Receptor (i.e. Estrogen Receptor+ and/or Progesterone Receptor+) positive invasive or non-invasive breast cancer (BC) (Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) 2005; Howell et al 2005)
A substantial portion of the patients using tamoxifen therapy for many years are reported to suffer from the hair loss (HL) or hair thinning (Gallicchio et al 2013)
Rationality for safety and availability When taking into account the aforementioned potential positive effects and risks of the treatment strategies, vitamin C and folic acid, providing only local use, are more likely to be the most potential and effective treatment agents due to the fact that they have a short halflife duration and that vitamin C is stored in the body for a long time, leading to increased levels in the systemic circulation and preventing the breast cancer recurrence
Summary
Tamoxifen and Aromatase Inhibitors (AIs) currently hold an important place as endocrine therapy (ET) in adjuvant and/or metastatic setting of the patients with Hormone Receptor (i.e. Estrogen Receptor+ and/or Progesterone Receptor+) positive invasive or non-invasive breast cancer (BC) (Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) 2005; Howell et al 2005). Because the endocrine therapy-induced hair loss (ETIHL) negatively effects the sociocultural status and quality of life, it is a major problem and remains a therapeutic challenge in patients with BC, should be managed by effective treatment options which are capable to stop the HL rather than additional psychological or prosthetic options.
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