Taxanes - Nice Guidelines and Rsk Of Long Term Hair Loss



I was just looking through the Nice Guidelines on early breast cancer and note that some have been revised.  I see there is more specific advice to discuss with patients the benefits and risks of taxane treatments (like Paclitaxel,  Docetaxel,Taxotere etc) beforehand.


Amongst other things, it now states (to advise) that:


“some people have long term hair loss after treatment with taxanes”.


I am glad that there is some recognition of this at last,  especially out of respect to the people that this has happened to.  I had taxane treatment and knew about this risk beforehand.  However when I queried it with Oncologist,  he said that he was not aware of this happening.  I also went to a session on hairloss at Maggie’s, and the presenters tried to make out I had got this wrong!  Such ignorance was only two years ago. I hope Organisations adapt their information if not already. 


Knowing this beforehand did not stop me from having tax treatment.    It may be harsh, and can possibly deplete your neutrophylls to a dangerous level.  But it can also do the job very well and was a good choice of action. However,  at least I was making a fully informed choice.   I also tried to reduce the hair risk by using cold cap and protecting the hair follicles to some degree even though I had had a buzz cut.  


Getting my hair fully back was important to me - I have enough reminders of BC all over my body - don’t need lack of head hair as well. .  Mind you,  I got it back and then started Anastrazole  and just kept my fingers crossed that it was not going to deplete with that…Been on it just over a year and it’s good for now ?


Regards,  Chick ? X



Thank you Chick, that is very interesting.


At my first session with the Medical Oncologist after my wounds had healed, I was seen first by his registrar, who tried to push me into having chemo. I had already been told by the consultant surgeon that radiotherapy, hormone therapy and bisphosphonate therapy were all ‘mandatory’, but that I was in the ‘borderline group of women’ who might or might not benefit from chemo, some of whom are being over-treated. I explained this to the registrar who informed me stoutly: ‘He’s a surgeon. We’re oncologists and are the experts.’ Eh hm. The ‘He’ here was the Principal Consultant Breast Surgeon and was quoting from my MDT meeting, but never mind.


After a testing time with the registrar (whom I suspect was very new to that level), the Consultant MO came in. I explained my reservations about chemo, especially re my medical history, and indicated I had taken information from only reputable sites: the NHS, Breast Cancer Care, Cancer Resarch UK and Macmillan. He agreed those are the ones they recommend.


I asked the CMO if I was correct in thinking that chemo can cause long term effects. After a thoughtful pause, he said, ‘Yes. It can prompt leukaemia, heart problems, damage to your immune system and your hair might not grow back.’ He then remained silent and did not attempt to suggest that those problems are rare. He was sympathetic to my reasons for turning it down, and observed I was making an informed decision.


I am not wanting to put others off from having chemo. Some patients undoubtedly benefit from it. Even so, as you say Chic, it is important for the patient to make an informed decision and to know what they could be in for. The CMO I refer to is a very honest man with a very high reputation in research.


You might find this paper interesting. (I referred to it in a post on a different thread.)


Aromatase inhibitor-induced arthralgia: a review

 by Dr. P Niravath, Medicine Department, Lester and Sue Smith Breast Center, Baylor College of Medicine, Houston, USA

Published by Oxford University Press on behalf of the European Society for Medical Oncology


This review focuses on the arthralgia related to aromatase inhibitor (AI) therapy, as this is an extremely common problem among breast cancer patients which negatively impacts on day-to-day well-being.


Arthralgia is referred to as Aromatase Inhibitor-induced Arthralgia (AIA).




Risk Factors and Associations

 Many factors have been shown to be associated with higher risk of developing AIA, though the underlying mechanism is still not understood.


Factors that have been associated with higher incidence of AIA include prior hormone replacement therapy [8, 35] and previous chemotherapy before beginning an AI [35]. A **history of having specifically received a taxane was associated with a higher rate of AIA, with 62% of such women developing this problem when compared with 37% who had never received chemotherapy [**6].


Regards to everyone on this stony path.