Life-saving treatments have significantly improved survival rates among patients with breast cancer, but these therapies are associated with many adverse effects, specifically affecting the hair, skin, and nails. While there is a small armamentarium for these complications, few studies are available that demonstrate the efficacy of various drugs at preventing or treating these conditions beyond anecdotal evidence.
A recent study provided reassurance that prescribing spironolactone to treat androgenic alopecia among patients who previously had breast cancer is likely safe. According to the findings, this therapy was not associated with an increased risk for breast cancer recurrence among survivors.
“Several studies have hinted at the safety of spironolactone in this population, though messaging from oncology and even dermatology has suggested otherwise,” said Adam Friedman, MD, FAAD, corresponding author and interim chair of the dermatology program at George Washington University School of Medicine.
While used to treat androgen-dependent conditions, such as acne and hidradenitis suppurativa, the safety of spironolactone usage among patients with estrogen-dependent malignancies for alopecia has been questioned due to its anti-androgen and pro-estrogen effects. “This study sought to add meaningful data to this debate in hopes of allaying said concerns and enabling physicians to comfortably use this medication,” he added.
To determine whether there was a possible risk for breast cancer recurrence, Dr Friedman and his colleagues used data from the Humana Insurance database to identify patients with a history of breast cancer and stratified them based on spironolactone prescription. They analyzed patient characteristics and cancer recurrence rates and compared them between cohorts.
Overall, the researchers found no association between spironolactone and increased breast cancer recurrence after performing a propensity-matching, adjusted Cox-regression analysis (adjusted hazard ratio [HR], 0.966 [0.807-1.156.]; p=0.953), with recurrence occurring within the expected range within 1-2 years after treatment. In congruence with past data, alcohol abuse was found to be associated with increased BC recurrence (adjusted-HR=2.304 [1.324-4.008]; p=0.003)
“I was more relieved than surprised, as we have so little in our armament to help these patients,” said Dr Friedman when asked about the results. “Interestingly though, we found the alcohol intake was positively associated with recurrence, which is consistent with past studies,” he added.
“There are several next steps,” said Dr Friedman. The first step, he said, would be to prospectively study patients on spironolactone with a positive history of breast cancer.
“From the perspective of someone who runs a supportive oncodermatology program and is eager for evidenced-based approaches to treat cancer–therapy-associated cutaneous adverse events, evidence further supporting the use of spironolactone for persistent chemotherapy induced alopecia would be very meaningful,” he said, adding “my experience with spironolactone in this area has been good, but it is certainly anecdotal.”
Overall, the study findings support the safety of spironolactone to treat hair loss in breast cancer survivors.
Wei C, Bovonratwet P, Gu A, et al. Spironolactone use does not increase the risk of female breast cancer recurrence: A retrospective analysis. Published online May 21, 2020. J Am Acad Dermatol. doi:10.1016/j.jaad.2020.05.081