Endocrine Therapy–Induced Alopecia in Patients With Breast Cancer

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Abstract
Breast cancer is the most common malignant neoplasm among women in the United States, with approximately 250 000 new cases diagnosed in 2016.1 Despite the high numbers, the survival of patients with early breast cancer (stages I, IIA, IIB, and IIIA) is greater than 80%. Cytotoxic chemotherapy and endocrine therapy (ET) have been the cornerstone in the management of breast cancer. Endocrine therapy, including aromatase inhibitors and selective estrogen receptor modulators, have shown benefits in the adjuvant and therapeutic setting for premenopausal or postmenopausal women with early-stage or advanced breast cancer.2,3 Despite their benefit, ETs are known to have substantial adverse events (AEs) such as hot flashes, mood disorders, osteopenia, and arthralgias.4 Among 236 patients treated with aromatase inhibitors, 8% discontinued treatment owing to alopecia.5 An alopecia meta-analysis of 13 415 patients in 35 clinical trials revealed an overall incidence of alopecia of 4.4%, with the highest incidence in tamoxifen-treated patients (25.4%).6 Additionally, in a survey-based study including a total of 851 female patients with breast cancer receiving aromatase inhibitors, 34% reported hair loss or hair thinning during their last month of therapy, and these hair changes were independent of previous chemotherapy and age.7 To our knowledge, the clinical characteristics, impact on quality of life (QoL), and response to dermatologic therapy of the ET-induced alopecia (EIA) have not been systematically described. This study aims to characterize EIA in patients with breast cancer.

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