Preclinical Study Offers Hope Against Hair Loss During Chemotherapy
Madison, Wisconsin - The same drug that keeps the dentist’s Novocain right where it’s injected soon could help cancer patients keep their hair.
A new University of Wisconsin-Madison study outlines a new strategy using a vasoconstrictor (a drug that narrows blood vessels) to save the hair follicles of patients who undergo chemotherapy and radiation. By constricting blood flow to an area of skin, a simple topical application can mitigate the effects of radiation and small-molecule drugs.
Chemotherapy drugs have been developed to attack rapidly dividing cancer cells, but they attack healthy cells that divide rapidly, too. Hair follicle cells are some of the fastest-dividing cells in the body, which is why many chemotherapy patients lose their hair.
But by temporarily constricting the blood vessels that sit a millimeter under the skin, hair follicles can be spared from the effects of chemotherapy, according to the study published in the International Journal of Cancer. The vasoconstrictor additive in your dentist’s Novocain constricts blood vessels to keep the numbing agent localized, providing some relief from the dental work while keeping your whole face from going numb.
“That’s essentially what’s happening here; we’re keeping chemotherapy drugs away from the outer skin and hair follicles where the vasoconstrictor has been topically applied,” said William Fahl, professor of oncology at the School of Medicine and Public Health and member of the UW Carbone Cancer Center.
Fahl was testing other topically applied drugs that could provide protection against radiation, mixed with vasoconstrictors to provide localized protection. In control studies without the protective drug, he observed the protective effect from the vasoconstrictor alone.
“Preventing alopecia (hair loss) is a big deal,” said Fahl. “When you walk through the cancer clinic here at the UW, the single largest poster on the first floor shows women what they’re going to look like after chemotherapy so they can emotionally prepare themselves. There is a store downstairs that sells hats, wigs, et cetera, specifically for patients suffering from treatment-related hair loss. What if we as an institution didn’t have to do that? I’d like to see that happen. My responsibility as a scientist is to make sure that this technology succeeds and solves these terrible problems.”
In an unrelated study, alopecia was ranked second among unwanted side effects by patients. First was the perceived effect on the family or partner. Another unrelated study cited alopecia as the worst anticipated side effect by 58 percent of women preparing for chemotherapy.
The same technology has already successfully made it through several clinical trials in treating radiation dermatitis, (radiation burn) and will be tested soon for oral mucositis.
Roughly 60 percent of patients who undergo a 30-day course of radiotherapy develop radiation dermatitis, ranging from a mild skin irritation to something more painful and destructive than the worst sunburn of your life. Severe cases have caused patients to stop therapy early. Irradiating tissue produces oxygen free radicals - highly reactive molecules - that make lethal chemical changes to cells and tissues; in radiotherapy, radiation is used to attack oxygen-rich tumors, but other tissues in the radiotherapy field in the presence of oxygen suffer from collateral damage. The topical vasoconstrictor treatment depletes skin of oxygen for a short time, providing some protection those skin cells from free radicals.
Also, nearly 70 percent of patients undergoing head and neck radiotherapy develop moderate or severe oral mucositis and suffer through very painful mouth. In severe cases, patients cannot bear to talk and must be fed through a feeding tube. The cost of managing these symptoms alone averaged $43,000 per patient in 2001. An upcoming clinical trial will test Fahl’s vasoconstrictor drug by way of an atomizing spray, applied to the mouth 15 minutes before radiotherapy and chemotherapy.
Fahl and colleagues have completed three clinical trials at the UW using the vasoconstrictor.
The next scheduled trial is a study to determine that the vasoconstrictor is safe and is effective in suppressing oral mucositis in bone-marrow transplant patients receiving cytoxan and total body irradiation. An additional study is being planned for alopecia.
According to Fahl, the greatest roadblock now in getting this technology to the market is funding the necessary trials to demonstrate safety and efficacy.
Date Published: 07/23/2014