Early-Onset Alopecia May Signal Chemotherapy Response for Ovarian Cancer

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Onset of alopecia, a common side effect of chemotherapy, within the first 3 cycles of platinum- and taxane-based chemotherapy was associated with improved overall survival (OS) among patients with epithelial ovarian cancer who completed 6 cycles of treatment.

These results, published in the European Journal of Cancer, are taken from a meta-analysis of four prospective phase III trials that included 5,114 patients assigned platinum- and taxane-based chemotherapy for advanced epithelial ovarian cancer.

“This is the first time to reveal an association of alopecia with chemotherapy response rates and survival in patients with advanced epithelial ovarian cancer,” wrote researchers led by Jalid Sehouli, MD, of the department of gynecology at the University of Berlin, Charité, Berlin, Germany.

The researchers noted two limitations of these results. First, only 5% of all the patients and 2.8% of those who completed 6 cycles of therapy did not experience grade 2 alopecia. Second, the studies included in the meta-analysis may have under- or over-reported alopecia.

“Even though our results are important and serve to further enlighten the associations between toxicity and efficacy of cytotoxic chemotherapy, the exact underlying mechanisms and pathways can only be speculative,” Sehouli and colleagues wrote.

In the analysis, the researchers found that 92% of the 5,114 patients had documented alopecia (grade 0, 2.4%; grade 1, 2.9%; grade 2, 94.7%).

Conducting a univariate analysis, the researchers found that patients who had grade 0 or grade 1 alopecia had significantly worse progression-free survival (PFS) and OS compared with those patients who had grade 2 alopecia.

In order to eliminate any bias for having received a lower dose of chemotherapy, the researchers next looked at only those patients who completed 6 or more cycles of treatment (89%). In this analysis, grade of alopecia was no longer significantly associated with survival outcomes. Instead, the researchers found that time of alopecia onset was linked with survival. Specifically, those patients who had grade 2 alopecia by cycle 3 of treatment had significantly longer OS than those who had alopecia onset later (hazard ratio [HR] = 1.25; 95% CI, 1.04-1.50). However, early-onset alopecia was not associated with an improvement in PFS.

“When adjusting for the common clinicopathologic features such as postoperative tumor residuals, histology, and FIGO stage, early-onset-up to cycle 4-grade 2 alopecia appeared to significantly correlate with a more favorable OS,” the researchers wrote. “It needs to be further elucidated whether early-onset alopecia is just a surrogate marker for higher sensitivity to chemotherapy and hence associated with a longer survival or if other unidentified biological pathways are underlying that correlate alopecia with cytotoxicity and survival.”