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Early alopecia linked to favorable outcomes in epithelial ovarian cancer
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Patients with primary epithelial ovarian cancer who experienced early-onset grade 2 alopecia with chemotherapy demonstrated significantly improved OS, according to a retrospective analysis of four randomized, phase 3 trials.
However, it is unclear whether early-onset alopecia is a surrogate marker for higher sensitivity to chemotherapy or if other underlying biological pathways correlate alopecia with cytotoxicity and survival, the researchers wrote.
“Among all chemotherapy induced side-effects, cancer patients have ranked loss of hair as the second most severe one,” Jalid Sehouli, MD, of the department of gynecology at the University of Berlin, and colleagues wrote. “Clinical evidence has shown that some patients may tend to perceive alopecia as an indirect evidence of success of their chemotherapy regimen, as it reflects successful targeting of similarly rapid-growing cells by the toxic chemotherapy agent.”
No previous studies have evaluated the connection between alopecia and improved outcomes in patients with ovarian cancer, largely due to the lack of a sufficiently large cohort, according to the study background.
Sehouli and colleagues evaluated data from four prospective, randomized, phase 3 trials that evaluated platinum- and taxane-based first-line chemotherapy in 5,114 patients with advanced epithelial ovarian cancer.
Overall, 92% (n = 4,705; median age, 59 years) of these patients developed alopecia. Patients who developed alopecia received a median of six cycles of chemotherapy, and 89% of patients completed at least six cycles.
A majority of cases of alopecia were grade 2 (94.7%), whereas 2.9% were grade 1 and 2.4% were grade 0.
Among 1,157 patients evaluable for response, 34.6% achieved a complete response and 30.8% achieved a partial response. Complete response rates were similar among patients with grade 2 alopecia vs. grades 0 or 1 alopecia (OR = 1.28; 95% CI, 0.7-2.35).
Median OS in the entire patient cohort was 47.6 months (95% CI, 45.9-49.3).
OS was significantly longer among patients with grade 2 alopecia compared with patients who did not develop alopecia (48.8 months vs. 28.1 months; P ˂ .001). Grade 2 alopecia vs. grades 0 or 1 also was associated with higher rates of PFS (19 months vs. 13.8 months; P = .001).
When researchers adjusted the analyses for features such as postoperative tumor residuals, histology and International Federation of Gynecology and Obstetrics (FIGO) stage, early-onset grade 2 alopecia was still associated with improved OS, but not improved PFS.
Results also showed patients who developed alopecia at a later treatment stage experienced a higher mortality risk than patients with early-onset alopecia (HR = 1.25; 95% CI, 1.04-1.5).
“A number of studies have suggested that a lack of drug-specific toxicities is associated with rather poor survival outcomes,” Sehouli and colleagues concluded. “Therefore, finding surrogate markers of chemotherapy efficacy is still an interesting and potentially useful line of research. … The value of surrogate markers of hematological and non-hematological toxicities is therefore warranted to be prospectively assessed in future trials. … It needs to be further elucidated whether early-onset alopecia is just a surrogate marker for higher sensitivity to chemotherapy and hence associated with longer survival or if other unidentified biological pathways are underlying that correlate alopecia with cytotoxicity and survival.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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