High Dose Chemotherapy & Alopecia

Today I ran into a story that “some what” related to alopecia, however with breast cancer affecting our society in such a fashion I did want to make note of it. Roman Bystrianyk has posted the complete article at the healthsentinel.com site, feel free to check out the article in it’s entirety.

High dose chemotherapy is a treatment that uses very high doses of chemotherapy in an attempt to kill all the cancer cells. The bone marrow is not able to tolerate such high doses of chemotherapy, therefore bone marrow stem cells from the patient are collected prior to chemotherapy to give back to the patient once high dose chemotherapy is completed.

A study in the May issue of the Annals of Oncology confirms that this form of treatment provided no advantage over conventional chemotherapy in long-term survival. The study analyzed 2 groups of patients – one receiving standard chemotherapy and the other receiving high dose therapy or HDT.

At the end of the study in the conventional group of 137 patients 33% had died and 40% had a first recurrence of breast cancer and in the HDT group 38% had died and 43% had a first recurrence of breast cancer. The relapse free/survival rate was “59% and 57%” in the conventional chemotherapy and HDT groups, respectively.

The high dose chemotherapy group clearly suffered a great deal more adverse treatment-related effects:

Nausea/Vomiting occurred in 5% of the conventional group and 46% of the high dose group.

Mucositis, or inflammation of the mouth lining, contributing to pain and difficulty swallowing occurred in 2% of the conventional group and 22% of the high dose group.

Hair loss or alopecia occurred in 9% of the conventional group and 100% of the high dose group.

Leucpenia, or decrease in the number of white blood cells, occurred in 14% of the conventional group and 100% of the high dose group.

Thrombocytopenia, or a decrease in the number of platelets in the blood, resulting in the potential for increased bleeding and decreased ability for clotting occurred in 0% of the conventional group and 100% of the high dose group.

Neutropenic fever, fever due to infections that develop after an individual’s white blood cells have decreased, occurred in 3% of the conventional group and 24% of the high dose group.

Although quality of life was not documented in this study other studies have demonstrated significantly “worse quality of life for patients” receiving high dose chemotherapy at 3-6 months. Although at 1 year the differences between the high dose and conventional groups in severity of symptoms had narrowed and were no longer significantly different.

It is estimated that over 40,000 women with primary breast cancer have received high dose therapy outside of randomized trials in the 1990s when no randomized trials were available. This and other studies have now demonstrated that there is no benefit for such a treatment strategy.

The authors unfortunately note that, “this emphasizes the need for high-level evidence before new treatments, however promising they seem, are adopted into routine medical practice.”

SOURCE: Annals of Oncology, May 2005

Posted in Chemotherapy & Alopecia