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Retrospective cohort study of CDK4/6-inhibitor-induced alopecia in breast cancer patients

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Abstract

Purpose

Dermatologic adverse events commonly result in the interruption of oncologic treatment, and targeted therapies are the most frequently interrupted class of anticancer agents. Alopecia is a common cutaneous adverse event reported with CK4/6i therapy. Though the clinical characteristics and therapeutic response of EIA have been well documented, few studies have characterized alopecia in patients treated with CDK4/6i.

Methods

This study analyzed a retrospective cohort of 28 breast cancer patients diagnosed with endocrine-induced alopecia (EIA) or CDKiA. Comparative analysis of the clinical characteristics of alopecia and therapeutic response to minoxidil was conducted. Therapeutic response to minoxidil (LDOM or topical [5%] solution or foam) was assessed by both Dean Scale and qualitative clinical improvement by comparison of pretreatment and posttreatment clinical images by single-blinded, board-certified academic dermatologists (ST and BD).

Results

CDKiA was clinically similar to androgenetic alopecia and specific vertex involvement was more common in patients treated with CDK4/6i + ET than endocrine monotherapy (n = 7 [70.0%] vs n = 4 [36.4%]; p = 0.04), respectively. After 4–6 months of minoxidil, there was a moderate to significant qualitative alopecia improvement in 80% of CDKiA patients versus 94.4% of EIA patients. Additionally, superior improvement of mean Dean Score grade was observed in EIA (with change from pre- to posttreatment − 0.44; p = 0.0002).

Conclusion

Compared to endocrine monotherapy, patients on combination CDK4/6i + ET had greater extent of vertex involvement and were more recalcitrant to minoxidil. The preferential vertex involvement observed in CDKiA suggests that combination therapy with minoxidil and topical antiandrogens with poor systemic absorption should be studied in this setting.

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Data Availability

Not applicable.

Code availability

Not applicable.

Abbreviations

EIA:

Endocrine therapy-induced alopecia

CDK4/6i:

Cyclin-dependent kinase 4 and 6 inhibitors

CDKiA:

CDK4/6i-induced alopecia

BC:

Breast cancer

CIA:

Chemotherapy-induced alopecia

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Funding

AM is supported by the Pelotonia Scholars Program, and BD is supported by a Dermatology Foundation Career Development Award.

Author information

Authors and Affiliations

  1. The Ohio State University College of Medicine, Columbus, OH, USA

    Abena Minta, Lucy Rose & Candice Park

  2. Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Bhuvaneswari Ramaswamy, Daniel Stover, Margaret Gatti-Mays, Mathew Cherian, Nicole Williams, Preeti Sudheendra, Robert Wesolowski & Sagar Sardesai

  3. Department of Medical Oncology, Yale Cancer Center, New Haven, CT, USA

    Maryam Lustberg

  4. Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA

    Charles L. Loprinzi, Kathryn J. Ruddy & Elizabeth Cathcart-Rake

  5. Department of Dermatology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Stephanie Trovato & Brittany Dulmage

Authors
  1. Abena Minta
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  2. Lucy Rose
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  3. Candice Park
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Contributions

The initial draft of the manuscript was written by Abena Minta and Lucy Rose, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Brittany Dulmage.

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Ethics approval

This study was approved by the Ohio State University Institutional Review Board (IRB#2021H0264).

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Not applicable.

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Not applicable.

Competing interests

Dr. Loprinzi reports personal fees from PledPharma, personal fees from Disarm Therapeutics, personal fees from Asahi Kasei/Veloxis, personal fees from Metys Pharmaceuticals, personal fees from OnQuality, personal fees from Mitsubishi Tanabe, personal fees from NKMax, personal fees from Novartis, personal fees from HengRui, personal fees from Nuro Bio, personal fees from Osmol Therapeutics, Inc., personal fees from Grunenthal, personal fees from Genentech, personal fees from Bexion, personal fees from Emmes Company, personal fees from Pfizer, and personal fees from Toray, all outside the submitted work.

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Minta, A., Rose, L., Park, C. et al. Retrospective cohort study of CDK4/6-inhibitor-induced alopecia in breast cancer patients. Support Care Cancer 31, 717 (2023). https://doi.org/10.1007/s00520-023-08160-0

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