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© 2003 American Society for Clinical Oncology
Calcitriol and Alopecia—Is it the Hair Apparent?Austin & Repatriation Medical Centre, Victoria, Australia To the Editor: The recent article by Beer et al1 describes the use of high-dose calcitriol and docetaxel in metastatic prostate cancer. Their analysis indicated that continued investigation of this regimen was warranted. Perhaps of further interest was what the regimen did not show. Alopecia resulting from docetaxel is dose dependent. About 95% of patients who receive docetaxel at 100 mg/m2 experience a grade 3 alopecia. The incidence of alopecia is reduced with lower doses of docetaxel. In previous studies, weekly schedules of docetaxel in breast cancer resulted in 14% to 20% of patients with a grade 2/3 alopecia.2–3 Similarly, 13% of patients receiving weekly docetaxel for non–small-cell lung cancer developed severe alopecia.4 Doses of docetaxel used in these studies ranged from 35 to 40 mg/m2. Calcitriol is a vitamin D3 analog. Several studies have been conducted evaluating calcitriol as a compound to prevent alopecia associated with antineoplastic therapy. Experimental data in animal models indicate that topical calcitriol may protect against chemotherapy-induced alopecia.5 Protection was noted over the entire animal, and not just the site of topical application. In a second study, investigators concluded that calcitriol resulted in accelerated and qualitatively improved hair regrowth. 6 However, a phase I trial of 14 patients failed to show efficacy for topical calcitriol in the prevention of chemotherapy-induced alopecia.7 Finally, vitamin D3 resistance may also play a role in alopecia.8 The article by Beer et al1 did not mention alopecia as a toxicity in their patient group. They did include toxicities that were only recorded once, so perhaps alopecia was an oversight. One further explanation for the lack of mention of alopecia as a toxicity may be explained by the high-dose calcitriol. Beer et al’s current study comparing docetaxel plus calcitriol versus docetaxel may help clarify this phenomenon. REFERENCES
1. Beer TM, Eilers KM, Garzotto M, Egorin MJ, Lowe BA, Henner WD: Weekly high-dose calcitriol and docetaxel in metastatic androgen-independent prostate cancer. J Clin Oncol 21:123–128, 2003
2. Hainsworth JD, Burris HA 3rd, Yardley DA, et al: Weekly docetaxel in the treatment of elderly patients with advanced breast cancer: A Minnie Pearl Cancer Research Network phase II trial. J Clin Oncol 19:3500–3505, 2001 3. Jackisch C, Eibach HW, Knuth A, et al: Phase-II trial of docetaxel weekly as dose dense treatment in metastatic breast cancer (MBC). Proc Am Soc Clin Oncol 2000;19:108a (abstract 417) 4. Hainsworth JD, Burris HA 3rd, Litchy S, et al: Weekly docetaxel in the treatment of elderly patients with advanced non-small cell lung carcinoma. A Minnie Pearl Cancer Research Network Phase II Trial. Cancer 89:328–333, 2000[CrossRef][Medline]
5. Jimenez JJ, Yunis AA: Protection from chemotherapy-induced alopecia from 1, 25-dihydroxyvitamin D3. Cancer Res 52:5123–5125, 1992
6. Paus R, Schilli MD, Menrad A, et al: Topical calcitriol enhances normal hair re-growth but does not prevent chemotherapy induced alopeica in mice. Cancer Res 56:4438–4443, 1996 7. Hidalgo M, Rinaldi D, Medina G, et al: A Phase I trial of topical topitriol (calcitriol, 1, 25-dihydroxyvitamin D3) to prevent chemotherapy-induced alopecia. Anticancer Drugs 10:393–395, 1999[Medline] 8. Hochberg Z, Benederli A, Levy J, et al: 1, 25-dihydroxyvitamin D resistance, rickets and alopecia. Am J Med 77:805–811, 1984[CrossRef][Medline]
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Copyright © 2003 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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