Chemotherapy is a type of cancer treatment that uses one or more anti-cancer drugs as part of a standardized chemotherapy regimen. Chemotherapy may be given with a curative intent, or it may aim to prolong life or to reduce symptoms. Many chemotherapy drugs have adverse effects; one of such is hair loss or alopecia.
Recently researchers of The University of Manchester have discovered a new strategy for how to protect hair follicles from chemotherapy, which could lead to new treatments that prevent chemotherapy-induced hair loss -- arguably one of the most psychologically distressing side effects of modern cancer therapy.
Hair loss or Alopecia when it results from cancer treatment can cause great distress. In the case of treatment with taxanes, hair loss can be permanent. Now, laboratory research has proposed away that could prevent alopecia due to this type of chemotherapy.
Hair Loss or Alopecia
Hair loss, also called alopecia, maybe a side effect of chemotherapy, targeted therapy, radiation therapy, or bone marrow/stem cell transplants. These treatments can cause hair loss by harming the cells that help hair grow. Hair loss may occur throughout the body,including the head, face, arms, legs, underarms, and pubic area. Hair may fallout entirely, slowly, or in sections. A person's hair may also simply become thin, sometimes unnoticeable, and it may become duller or dryer. Hair loss related to cancer treatment is usually temporary. Most of the time, hair will grow back. Rarely, it may remain thin.
Hair does not usually fall out right away after you start chemotherapy. Most of the time, it begins to fall after several weeks or cycles of treatment. Hair loss tends to increase 1 to 2 months into treatment.
The amount of hair loss varies from person to person. Even people taking the same drugs for the same cancer will have a different amount of hair loss. How much hair you lose depends on the drug and the dose. It also depends on whether you receive the drug as a pill, into a vein, or on the skin.
The new study to prevent hair loss due to chemotherapy
The researchers found that taxanes are toxic to specialized niches of cells at the base of hair follicles.
These niches contain cells that divide rapidly and are essential for producing hair.
In further experiments, the team found that CDK4/6 inhibitors, a class of drug that halts cell division, can prevent the damage that taxane inflicts in the hair follicle.
In addition, the CDK4/6 inhibitors worked in a way that did not inflict further damage on the hair follicle.
"When we bathed organ cultured human scalp hair follicles inCDK4/6 inhibitors," says lead and corresponding study author Talveen S. Purba, Ph.D., "the hair follicles were much less susceptible to the damaging effects of taxanes."
Purba is a research associate in the Centre for Dermatology Research at the University of Manchester in the United Kingdom.
Hair losses from Chemotherapy
"Taxanes are a leading cause of severe and often permanent chemotherapy induced alopecia," write the authors, who go on to discuss the need for new and effective strategies to prevent this type of hair loss.
Hair loss is a very distressing and sometimes enduring side effect of chemotherapy.
Chemotherapy induced alopecia can damage an individual's body image, self‐esteem, and quality of life, especially when the hair does not grow back.
The authors note that as many as 8% of people likely reject chemotherapy because of this"psychosocial burden."
They hope that the findings will spur the development of skin medicines that doctors can apply to the skin of their chemotherapy patients to reduce hair loss.
Treatments that temporarily slow or stop cell division in hair follicles could help to boost the effectiveness of hair preserving treatments such as scalp cooling, which can be "unsatisfactory and difficult to predict."
The findings could also help to develop treatments to prevent hair loss on other sites of the body, such as eyebrows, beards, and pubic hair,which individuals may also value for "cosmetic, cultural, religious, and psychosocial," reasons.
The CDK4/6 inhibitor protected hair follicles
During the study, Purba and colleagues focused on two taxanes paclitaxel and docetaxel that doctors use in the treatment of solid tumors,such as in the breast and lung.
The researchers tested the drugs on hair follicles they cultured in the laboratory under conditions that were as natural as possible. The hair follicles came from the scalps of consenting patients.
Hair follicles are the "mini organ" that is easy to remove whole and readily lends itself to laboratory experimentation.
The team noticed that paclitaxel and docetaxel induced massive damage to cell division processes and triggered cell death in follicle cells that are essential for hair production.
Those follicle cells that underwent damage included transit amplifying cells, which divide rapidly, and their progenitor, or stem cells.Impairment of this cell population likely explains the "severity and permanence of taxane chemotherapy induced alopecia."
When they administered palbociclib, a CDK4/6 inhibitor to the organ cultured hair follicles before exposing them to paclitaxel, the researchers found that it protected without inflicting further damage.
Urgent need for more work on chemotherapy induced hair loss
Nevertheless, the authors were careful to acknowledge that their findings are proof of principle that this type of cell protective therapy can limit the damage that taxane chemotherapy can induce in hair follicles.
The team points out that there is an urgent need for more work on how to prevent hair loss in cancer patients.
Furthermore, there is a need to find out how to regenerate hair follicles in order to help those who have already lost their hair permanently following chemotherapy.
However, there are many long standing questions that still demand answers. Why is it, for instance, that chemotherapy hair loss is more severe in some people than others, despite all receiving the same drug and dose?
Also, why do some chemotherapy treatments and drug combinations result in mild hair loss, while others cause severe or permanent loss?
"Despite the fact that taxanes have been used in the clinic for decades, and have long been known to cause hair loss, we're only now scratching the surface of how they damage the human hair follicle." Dr Purba said
He added: "We also don't really know why some patients show greater hair loss than others even though they get the same drug and drug-dose, and why it is that certain chemotherapy regimens and drug combinations have much worse outcomes than others"
"We need time to further develop approaches like this to not only prevent hair loss, but promote hair follicle regeneration in patients who have already lost their hair due to chemotherapy."