title: Alopecia in patients treated with molecularly targeted anticancer therapies.
abstract: BACKGROUND
  The introduction of molecularly targeted anticancer therapies presents new challenges, among which dermatologic adverse events are noteworthy. Alopecia in particular is frequently reported, but the true incidence is not known.
  
  
  METHODS
  We sought to ascertain the incidence and risk of developing alopecia during treatment with approved inhibitors of oncogenic pathways and molecules [anaplastic lymphoma kinase, breakpoint cluster region-abelson, B-rapidly accelerated fibrosarcoma, Bruton's tyrosine kinase, cytotoxic T-lymphocyte antigen-4, epidermal growth factor receptor, human epidermal growth factor receptor-2, Janus kinase, MAPK/ERK (extracellular signal-regulated kinase) Kinase, mammalian target of rapamycin, smoothened, vascular endothelial growth factor, vascular endothelial growth factor receptor, platelet derived growth factor receptor; proteasomes; CD20, CD30, CD52]. Electronic database (PubMed, Web of Science) and ASCO meeting abstract searches were conducted to identify clinical trials reporting alopecia. Meta-analysis was conducted utilizing fixed- or random-effects models.
  
  
  RESULTS
  The calculated overall incidence of all-grade alopecia was 14.7% [95% confidence interval (CI) 12.6% to 17.2%]-lowest with bortezomib, 2.2% (95% CI 0.4% to 10.9%), and highest with vismodegib, 56.9% (95% CI 50.5% to 63.1%). There was an increased risk of all-grade alopecia [relative risk (RR), 7.9 (95% CI 6.2-10.09, P ≤ 0.01)] compared with placebo, but when compared with chemotherapy, the risk was lower [RR, 0.32 (95% CI 0.2-0.55, P ≤ 0.01)].
  
  
  CONCLUSIONS
  Targeted therapies are associated with an increased risk of alopecia.
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, New York.
authors.forename: V R
authors.initials: VR
authors.lastname: Belum
authors.affiliation: Temple University School of Medicine, Philadelphia.
authors.forename: K
authors.initials: K
authors.lastname: Marulanda
authors.affiliation: Stony Brook University School of Medicine, Stony Brook.
authors.forename: C
authors.initials: C
authors.lastname: Ensslin
authors.affiliation: New York University School of Medicine, New York.
authors.forename: L
authors.initials: L
authors.lastname: Gorcey
authors.affiliation: Department of Dermatology, Weill Cornell Medical College, New York.
authors.forename: T
authors.initials: T
authors.lastname: Parikh
authors.affiliation: Division of Medical Oncology, Department of Medicine, State University of New York at Stony Brook, Stony Brook Division of Hematology and Oncology, Department of Medicine, Northport VA Medical Center, Northport.
authors.forename: S
authors.initials: S
authors.lastname: Wu
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Busam
authors.affiliation: Department of Dermatology, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany.
authors.forename: P A
authors.initials: PA
authors.lastname: Gerber
authors.affiliation: Dermatology Service, Memorial Sloan Kettering Cancer Center, New York lacoutum@mskcc.org.
authors.forename: M E
authors.initials: ME
authors.lastname: Lacouture
mesh_terms: D000505:Alopecia / Q000139:chemically induced* / Q000175:diagnosis; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002986:Clinical Trials as Topic / Q000379:methods; D006801:Humans; D058990:Molecular Targeted Therapy / Q000009:adverse effects*; D009369:Neoplasms / Q000175:diagnosis / Q000188:drug therapy
chemical_list: D000970:Antineoplastic Agents
keywords: adverse events; alopecia; antineoplastic agents; drug-induced alopecia; hair loss; targeted therapies