Permanent scalp alopecia related to breast cancer chemotherapy by sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel: a prospective study of 20 patients

Ann Oncol. 2012 Nov;23(11):2879-2884. doi: 10.1093/annonc/mds095. Epub 2012 May 9.


Background: To analyze the clinical and histological features of permanent alopecia following a sequential fluorouracil/epirubicin/cyclophosphamide (FEC) and docetaxel regimen for adjuvant breast cancer treatment.

Patients and methods: Women treated for breast cancer by a sequential adjuvant FEC and docetaxel regimen who developed permanent alopecia diagnosed between 2007 and 2011 were identified from the Department of Dermatology (Saint-Eloi Hospital, Montpellier, France) and the Department of Medical Oncology (CRLC Val d'Aurelle, Montpellier, France). Data were collected regarding demographics, type of cancer, delay of onset after chemotherapy, Dermatology Life Quality Index (DLQI), clinical description of the lesions, scalp biopsies, laboratory explorations investigating steroid hormonal, iron, zinc and thyroid status, therapy and outcome.

Results: Twenty white Caucasian females were included. Hair loss presented with a moderate or intense androgenetic-like pattern of scalp alopecia. Biopsy specimen examinations were normal or displayed the androgenetic-like pattern. Laboratory explorations ruled out iron or zinc deficiency and thyroid disorders and confirmed hormonal menopause without hyperandrogenism. The overall mean DLQI score reflected the distressing psychological consequences in the patients' lives. No spontaneous regrowth of the scalp hair was noted. Treatment including vitamins, minoxidil, psoralen and ultraviolet A therapy and spironolactone proved to be ineffective.

Conclusion: Permanent and severe alopecia is a newly reported complication of the FEC 100-docetaxel breast cancer regimen.

MeSH terms

  • Adult
  • Aged
  • Alopecia / chemically induced*
  • Alopecia / drug therapy
  • Alopecia / therapy
  • Antineoplastic Agents / adverse effects
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / adverse effects*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Breast Neoplasms / drug therapy*
  • Chemotherapy, Adjuvant / adverse effects
  • Cyclophosphamide / adverse effects
  • Cyclophosphamide / therapeutic use
  • Docetaxel
  • Epirubicin / adverse effects
  • Epirubicin / therapeutic use
  • Female
  • Ficusin / therapeutic use
  • Fluorouracil / adverse effects
  • Fluorouracil / therapeutic use
  • Humans
  • Middle Aged
  • Minoxidil / therapeutic use
  • Prospective Studies
  • Spironolactone / therapeutic use
  • Taxoids / adverse effects*
  • Taxoids / therapeutic use
  • Ultraviolet Therapy
  • Vitamins / therapeutic use


  • Antineoplastic Agents
  • Taxoids
  • Vitamins
  • Docetaxel
  • Spironolactone
  • Epirubicin
  • Minoxidil
  • Cyclophosphamide
  • Ficusin
  • Fluorouracil

Supplementary concepts

  • FEC protocol