A pilot study of the clinical efficacy of platelet-rich plasma (PRP) for the treatment of endocrine therapy-induced alopecia (EIA) and permanent chemotherapy-induced alopecia (pCIA) in breast cancer patients.

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Breast cancer is the most common cancer among women, with over 2 million new cases diagnosed worldwide in 2018. Modern therapies, consisting of chemotherapy and anti-hormonal therapy, are successfully used with a survival rate of greater than 80% in early stages. These anti-hormonal (endocrine) therapies are now recommended for as long as 5-10 years. Therefore, long-term side effects such as hair loss (alopecia) substantially compromise the quality of life in these patients. 8% of patients discontinue hormone therapy because of hair loss. Up to 25% suffer from hair loss because of the reduction of female hormones caused by the cancer treatment. Also, up to two thirds of patients treated with chemotherapy never fully grow back their hair afterwards. This can be a psychologically devastating event.Available treatments include minoxidil, a topical therapy that increases blood supply to the scalp, which has shown some improvement in hormone therapy-related hair loss, and the blood pressure medication spironolactone. There is, however, a need for further therapies for women who do not respond to minoxidil or spironolactone.Platelet Rich Plasma (PRP) was first used in orthopedic sports injuries to speed up recovery but has been increasingly used in dermatology for wound support, facial rejuvenation, and also hair loss. Platelets (thrombocytes) are a component of the blood that contains a high concentration of proteins with anti-inflammatory and growth-stimulating effects. PRP is obtained after blood centrifugation from the patient.In women with postmenopausal hair loss, PRP injections have shown a significant change in hair density and thickness even if the women had already received treatment with minoxidil or systemic therapy. Hair loss due to menopause resembles the cause of hair loss due to anti-hormonal therapy in cancer patients and suggests that PRP may be a suitable treatment for breast cancer patients suffering from this condition.In this pilot study, we want to treat breast cancer patients, who are experiencing hormone therapy- (EIA) and chemotherapy-related hair loss (pCIA), with PRP. 14 patients of each entity, EIA and pCIA, will be included. The patients will receive PRP injections on one half of their scalp whereas the other half of the scalp will not be treated, to serve as a study control. PRP is injected to the same half of the scalp once every 4 weeks for 12 weeks in a grid-like pattern. Treatment efficacy will be assessed at weeks 12 and 24 after the start of PRP. The effect on the quality of life will also be assessed. After 24 weeks, patients can cross over to a PRP treatment of the untreated side of their scalp if a benefit is seen.