A RECENT study has been conducted examining patients with breast cancer (BC) prescribed low-dose oral minoxidil (LDOM) for alopecia at NYU Langone Health from 2012–2023. The study required patients to have taken LDOM for at least one month, initiated LDOM during or after BC treatment, and documented side effects (SEs) or tolerability. Patients who received chemotherapy (CTX) in addition to surgery and/or radiation were compared to those treated with surgery and/or radiation alone.
SEs were documented at their first occurrence or upon worsening. Effectiveness was assessed through both patient and physician evaluations, including subjective exam findings and/or quantitative hair measurements. Categorical and numerical data were compared using Fisher’s exact tests and Mann-Whitney U tests, respectively.
51 female patients (median age 67 years) met the inclusion criteria and, of these, 25 (49.0%) received CTX, while 26 (51.0%) underwent surgery and/or radiation alone. Demographic factors, cardiovascular comorbidities, and concurrent medications linked to cardiovascular SEs were similar between both groups. The median LDOM dose was 1.25 mg/day (range: 0.3125–5 mg/day). A total of 29 patients (56.9%) reported 44 SEs, with no significant difference in SE incidence between the groups. Hypertrichosis accounted for 61.4% of the reported SEs. No pericardial or life-threatening SEs were observed. CTX patients experienced SEs earlier (median 191 days) compared to non-CTX patients (97 days, p=0.019).
Patients had various subtypes of alopecia, including female pattern hair loss, telogen effluvium, scarring alopecia, chemotherapy-induced alopecia, endocrine-induced alopecia, and multifactorial alopecia. Improvement or stability of alopecia was observed in all patients after 3–6 months of LDOM use. No significant difference in LDOM effectiveness was found between CTX and non-CTX groups (p=1). At ≥6 months, 3 (16.7%) CTX patients reported worsening alopecia, two of whom had physician-confirmed assessments, all of whom had prior taxane exposure, with some also receiving doxorubicin and cyclophosphamide.
This study is the first to explore LDOM use across various alopecia subtypes in patients with breast cancer, with extended follow-up and consideration of cardiovascular risk factors. The absence of severe cardiovascular SEs suggests LDOM’s tolerability in patients with potential cardiovascular comorbidities from BC treatments. The higher incidence of hypertrichosis may be attributable to inconsistencies in assessment methods. CTX patients reported earlier SEs, highlighting the need for monitoring delayed-onset SEs.
Katie Wright, EMJ
Reference
Zaminski D et al. Tolerability and effectiveness of low-dose oral minoxidil for alopecia in patients with breast cancer: a retrospective cohort study. J Am Acad Dermatol. 2024;DOI:10.1016/j.jaad.2024.11.048
