Thinning Hair
Thinning Hair

No one can stop hair loss completely. But you can have healthier, fuller and thicker hair while slowing down the rate of loss.

Anagen Effluvium: Hair Loss and the Cancer Patient

Most chemotherapy agents used to treat cancer are highly toxic and induce hair loss in an estimated average of 65% of cancer patients, depending on the type of drug. In fact, alopecia is one of the top three major adverse effects due to toxicity of these drugs. Although doctors and nurses tend to underestimate the tremendous psychological impact chemotherapy-induced hair loss causes cancer patients, it is a serious side effect that can negatively affect a patient’s overall cancer treatment outcome with the potential risks of depression, anxiety, and even rejection of certain chemotherapy regimens.4

Chemotherapy is the primary cause of a certain type of hair loss called anagen effluvium, which affects both scalp and body hair. At lower doses it can produce a telogen effluvium. The effects of chemotherapy are meant to interrupt rapidly dividing cancer cells. Unfortunately, hair in the growth phase is comprised of rapidly dividing cells too. With up to 90% of hair in the anagen phase at any given time, the hair loss can be dramatic. Typically it begins within the first few weeks of treatment and reaches its maximum loss in about two months. Hair loss caused by chemotherapy drugs is usually reversible, though it may take up to six months to start regrowth.29, 32, 90

Chemotherapy drugs are generally grouped into four major types, or classes. Each type carries a different risk of alopecia, but combination therapies using two or more drugs typically cause higher and more severe rates of loss:32


CHEMOTHERAPY DRUGS AND RISK OF HAIR LOSS

Antimicrotubule Agents(also known as plant alkaloids,

but some are derived from bacteria)
 149

Drug Names
Cancers Treated
% Patients Who Lose Hair 32
Vinca alkaloids:
vincristine, vinblastine, vinorelbine
Acute and chronic leukemias, bladder, breast, brain tumors, choriocarcinoma, Ewing’s sarcoma, head and neck, Hodgkin’s and non-Hodgkin’s lymphoma, Kaposi’s sarcoma, lung, multiple myeloma, ovarian, testicular, thyroid, Wilms’ tumor 150-152
Over 80%
Taxanes:
paclitaxel, docetaxel
Bladder, breast, esophageal, head and neck, Kaposi’s sarcoma, lung, melanoma, ovarian, prostate, stomach, and other solid tumor cancers 153-154
Over 80%
Podopyllotoxins:
etoposide, teniposide
Bladder, brain tumors, Ewing's sarcoma, Hodgkin’s and non-Hodgkin’s lymphoma, Kaposi’s sarcoma, lung, neuroblastoma, prostate, rhabdomyosarcoma, stomach, testicular, Wilms’ tumor 155
Over 80%
Camptothecan analogs:
irinotecan, topotecan
Chemoresistant ovarian and small cell lung cancer, metastatic colon and rectal cancers 156-157
Over 80%

Topoisomerase Inhibitors

Drug Names
Cancers Treated
% Patients Who Lose Hair 32
Type I:
irinotecan, topotecan
Chemoresistant ovarian and small cell lung cancer, metastatic colon and rectal cancers 156-157
60-100%
Type II:
amsacrine, doxorubicin, etoposide, etoposide phosphate, teniposide
Acute lymphocytic leukemia, bladder, brain tumors, Ewing's sarcoma, Hodgkin's and non-Hodgkin's lymphoma, Kaposi's sarcoma, lung, neuroblastoma, prostate, rhabdomyosarcoma, stomach, testicular, uterine, and Wilms’ tumor 155, 158
Over 60%

Alkylating agents

Drug Names
Cancers Treated
% Patients Who Lose Hair 32
Nitrogen mustards:
mechlorethamine, chlorambucil, cyclophosphamide, ifosfamide, melphalan
Used to treat many different cancers since they do not work on specific cancer cell phases. Types of cancers used for include:
Acute and chronic leukemia, breast, Hodgkin disease, lung, lymphoma, multiple myeloma, ovary, and sarcomas  159
Over 60%
Nitrosoureas:
streptozocin (Zanosar®), carmustine, and lomustine
Used to treat many different cancers since they do not work on specific cancer cell phases. Types of cancers used for include:
Acute and chronic leukemia, breast, Hodgkin disease, lung, lymphoma, multiple myeloma, ovary, and sarcomas 159
Over 60%
Triazines:
dacarbazine, temozolomide
Used to treat many different cancers since they do not work on specific cancer cell phases. Types of cancers used for include:
Acute and chronic leukemia, breast, Hodgkin disease, lung, lymphoma, multiple myeloma, ovary, and sarcomas 159
Over 60%
Platinum drugs:
carboplatin, cisplatin, oxaliplatin
Used to treat many different cancers since they do not work on specific cancer cell phases. Types of cancers used for include:
Acute and chronic leukemia, breast, Hodgkin disease, lung, lymphoma, multiple myeloma, ovary, and sarcomas 159
Over 60%

Antimetabolites

Drug Names
Cancers Treated
% Patients Who Lose Hair 32
5-fluorouracil, capecitabine, 6-mercaptopurine,methotrexate, gemcitabine, cytarabine, fludarabine, pemetrexed Breast, intestinal tract, ovary 159
10-50%

The good news is that even within some of the classes with higher risk of hair loss, there are some chemotherapy drugs where hair loss is unusual. These include:32

CHEMOTHERAPY DRUGS LESS LIKELY TO CAUSE HAIR LOSS
AGENT
CLASS OF DRUG
CARBOPLATIN 32
Alkylating Agent 159
CISPLATIN 32
Alkylating Agent 159
CARMUSTINE 32
Alkylating Agent 159
MITOXANTRONE 32
Topoisomerase Inhibitor 159
STREPTOZOCIN 32
Alkylating Agent 159

Table 26: Chemotherapy Drugs Less Likely to Cause Hair Loss

Disclaimer: This website is not intended to replace professional consultation, diagnosis, or treatment by a licensed physician. If you require any medical related advice, contact your physician promptly. Information at Thinninghair.com is exclusively of a general reference nature. Do not disregard medical advice or delay treatment as a result of accessing information at this site.
Also known as streptozotocin.
Oncovin®, Vincasar Pfs®
Alkaban-AQ®, Velban®
Navelbine®
Derived from the Pacific Yew tree, periwinkle plant, May apple plant, and the Asian Happy Tree.
Taxol®, Onxal™
Taxotere®
Toposar®, VePesid®, Etopophos®
Camptosar®
Hycamtin®
Camptosar®
Hycamtin®
Toposar®, VePesid®, Etopophos®
Vumon®
Cytoxan®
Hair loss is unusual in this specific drug.
Temodar®
Hair loss is unusual in this specific drug.
Hair loss is unusual in this specific drug.
5-FU
Xeloda®; hair loss is unusual in this specific drug.
Hair loss is unusual in this specific drug.
Hair loss is unusual in this specific drug.
Gemzar®
Ara-C®
Hair loss is unusual in this specific drug.
Alimta®