Time to Grade 2 Alopecia Linked to EOC Overall Survival

The time taken to grade 2 alopecia during epithelial ovarian cancer chemotherapy may be linked to patient overall survival

medwireNews: Epithelial ovarian cancer (EOC) patients who experience alopecia early on during platinum- or taxane-based chemotherapy may have better overall survival than those who take longer to lose their hair, suggests a meta-analysis published in the European Journal of Cancer.

However, the authors emphasise: “It needs to be further elucidated whether early onset alopecia is just a surrogate marker for higher sensitivity to chemotherapy and hence associated with a longer survival or if other unidentified biological pathways are underlying that correlate alopecia with cytotoxicity and survival.”

Pooled results from 4705 patients participating in one of four phase III trials of first-line treatment for advanced EOC showed that 2.4% of patients had no hair loss, 2.9% had grade 1 alopecia and 94.7% of patients experienced grade 2 alopecia.

Although initial analysis indicated that patients with grade 0 or 1 alopecia had significantly poorer progression-free and overall survival than those with grade 2 alopecia, the researchers were concerned that the range in the number of treatment cycles received might confound the findings.

To exclude such bias, data were re-examined for the 89.0% of patients who had received at least six chemotherapy cycles and multivariate analysis revealed no significant relationship between alopecia grade and survival, say Jalid Sehouli, from the University of Berlin in Germany, and co-authors.

Nevertheless, the team found that patients who had developed grade 2 alopecia by their third chemotherapy cycle had significantly longer overall survival than those who did not develop alopecia until later in treatment, with a hazard ratio of 1.25.

However, the timing of grade 2 alopecia did not significantly predict progression-free survival in this group.

“Even though our results are important and serve to further enlighten the associations between toxicity and efficacy of cytotoxic chemotherapy, the exact underlying mechanisms and pathways can only be speculative”, the researchers observe.

They conclude: “Our finding that the timing of complete alopecia appears to be a significant surrogate marker of response and outcome will need to be further validated before drawing any clinically relevant projections and treatment decisions.”


Sehouli J, Fotopoulou C, Erol E, et al. Alopecia as surrogate marker for chemotherapy response in patients with primary epithelial ovarian cancer: A metaanalysis of four prospective randomised phase III trials with 5114 patients. Eur J Cancer 2015; Advance online publication 11 March. doi:10.1016/j.ejca.2015.01.008

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