Hair and cancer

Chemotherapy hair loss

Chemotherapy drugs attack rapidly growing cancer cells.
As a drawback, chemotherapy also attacks other rapidly growing cells, such as hair follicle cells, hence causing hair loss.
Hair loss intensity depends on the chemotherapy regimen administered. The following chemotherapy treatments are known for causing varying degrees of hair loss ⁽¹⁾.

Agents that usually cause hair loss		Agents that sometimes cause hair loss		Agents that rarely cause hair loss
Adriamycin		Amsacrine		Carboplatin
Cyclophosphamide		Bleomycin		Capecitabine
Daunorubicin		Busulphan		Carmustine
Docetaxel		Cytarabine		Cisplatin
Epirubicin		5-Fluorouracil		Fludarabine
Etoposide		Gemcitabine		Methotrexate
Ifosphamide		Lomustine		Mitomycin C
Irinotecan		Melphalan		Mitroxantrone
Paclitaxel		Thiotepa		Procarbazine
Topotecan		Vinblastine		Raltritrexate
Vindesine		Vincristine		6-Marcaptopurine
Vinorelbine				Streptozotocin

Hair loss typically starts 1 to 3 weeks after chemotherapy begins.
Hair could fall out very quickly or gradually and your scalp may feel tender.
Hair loss will continue throughout the chemotherapy treatment until baldness, eventually.
The baldness period (between the moment maximum baldness is reached and first hair regrowth) is 20 weeks on average ⁽⁴⁾.
Duration from start of chemotherapy treatment until maximum hair recovery is on average 6 months (187 days) ⁽⁴⁾.
New hair texture and color may temporally be different from the hair you lost ^(1,2).
The pictures below represent the visual progression of hair pattern and macro pictures of the scalp, through and after chemotherapy ⁽³⁾.

The typical course of hair loss, as shown in a patient in group C (chemotherapy), demonstrated by (a) global photography, (b) phototrichogram in the frontal area and (c) phototrichogram in the occipital area.
Left to right, weeks 0, 3, 6, 18 and 28.

Week 0

Week 3

Week 6

Week 18

Week 28

Source of data: 3.V. Kanti et al. Analysis of quantitative changes in hair growth during treatment with chemotherapy or
tamoxifen in patients with breast cancer: a cohort study - British Journal of Dermatology (2014) 170, pp643–650

Persistent hair issues resulting from chemotherapy

More than 70% of patients who had breast cancer adjuvant chemotherapy with FEC > Docetaxel treatment suffer from hair loss even more than two years after the treatment. Dr. Ito, Hitachi Sogo Hospital - Breast Cancer Society of Japan - 2013

In a survey conducted 32 months after chemotherapy (median value), 50 patients (53%) responded that hair volume decreased, and 63 patients (74%) responded that hair became thinner. Dr. Watarai - Breast cancer society of Japan – 2010

Chemotherapy drugs cause “dystrophic anagen” (damage to hairs in the growing phase) and “dystrophic catagen” (damage to transition phase hairs). Dystrophic anagen hair follicles actually recover much more slowly than dystrophic catagen hair follicles ⁽⁵⁾.
Since generally 80% ⁽⁶⁾ of hair are in the growing phase (anagen phase), the hair regrowth process after chemotherapy hair loss may be a longer, resulting in persistent hair thinning and decreased hair volume.

Hormonal therapy hair issues

Hormonal therapy is used to treat breast cancers that are sensitive to hormones. It is intended to help reducing the risk of the breast cancer coming back after surgery, and also to treat cancer that has come back after treatment or has spread ⁽¹⁰⁾.
Tamoxifen (Nolvadex, Soltamox) causes hair thinning in aproximately 15% of the cases ^{(7, 8)}.
Estrogen level reducers like aromatase inhibitors (anastrozole - Arimidex, exemestane - Aromasin, letrozole - Femara) can cause hair thinning in 32,6% of the cases ⁽⁹⁾.


References

(1) Chemotherapy-induced Hair Loss. Trueb RM. Skin Therapy Lett. 2010 Jul-Aug;15 (7):5
(2) Mayo Clinic. Chemotherapy and hair loss: what to expect during treatment. Available at: www.mayoclinic.org/tests-procedures/chemotherapy/in-depth/hair-loss/art-20046920. Last accessed: September 30, 2014.
(3) Analysis of quantitative changes in hair growth during treatment with chemotherapy or tamoxifen in patients with breast cancer: a cohort study - V. Kanti, R. Nuwayhid, J. Lindner, K. Hillmann, A. Stroux, N. Bangemann, A. Kleine-Tebbe, U. Blume-Peytavi and N. Garcia Bartels - British Journal of Dermatology (2014) 170, pp643–650
(4) A randomized trial of minoxidil in chemotherapy-induced alopecia - Duvic, M et al- Journal of the American Academy of Dermatology - Vol.35, No.1, (July 1996), pp. 74-78
(5) Pathobiology of chemotherapy-induced hair loss - Vladimir A Botchkarev et al. - The Lancet Oncology, Vol 14, Issue 2, February 2013
(6) Indications that topical L-carnitin-L-tartrate promotes human hair growth in vivo - Kerstin Foitzik, Edo Hoting, Ulrike Heinrich, Hagen Tronnier, Ralf Paus - Journal of Dermatological Science (2007) 48, 141-144
(7) Alopecia With Endocrine Therapies in Patients With Cancer - V Saggar, S Wu, M Dickler, M Lacouture - The Oncologist 2013; 18:1126–1134
(8) Breast Cancer.org: Why and How Hair Loss Happens. Available at: www.breastcancer.org/tips/hair_skin_nails/hair_loss. Last accessed: September 30, 2014
(9) Breast cancer action group (2008) Side-effects revisited: women’s experiences with aromatase inhibitors. Zivian M, Salgado B - Available at: www.bcaction.org. (accessed october 3, 2014)
(10) www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-hormone-therapy

Meet CG428

CG428 is a botanical lotion intended to help hair recovery after chemotherapy hair loss.

A study suggest that the period of baldness, from maximum baldness to first regrowth, which is usually 20 weeks, was reduced by 5 to 16 weeks in subjects using the product ⁽¹⁾.


CG428 scientific data were presented at the following scientific conferences *:

2013 - Multinational Association of Supportive Care in Cancer (MASCC)
2013 - American Association for Cancer Research (AACR)
2014 - World Hair Research Congress (WHRC)
2014 - American Academy of Dermatology (AAD)
2014 - Multinational Association of Supportive Care in Cancer (MASCC)
2014 - World Congress on Breast Cancer (SIS)
2014 - Society of Integrative Oncology (SIO)
2014 - Critical Mass - Young Adult Cancer Alliance
2014 - San Antonio Breast Cancer Symposium (December 2014)
2015 - Multinational Association of Supportive Care in Cancer (MASCC)
*Oral presentation and/or poster.

(1) CARA - Assessment of the efficacy of CG428 in the recovery from chemotherapy induced alopecia in women (an open label evaluation), Japan 2013


CG428 contains a novel patented blend comprised of four botanicals ingredients: Citrus, Cocoa , Guarana and Onion.
Legacy Healthcare has developed and studied Coacillium® , a product for the treatment of autoimmune and inflammatory diseases, with an immune-sparing mode of action, allowing safe chronic use.
For more information on Coacillium, visit www.legacyhealthcare.ch

How CG428 works?

CG428 helps reestablishing the natural balance of the hair cycle when disturbed by chemotherapy and hormonal cancer treatments.
CG428 helps restoring the optimal environment required for healthy hair growth.
Apart from rare cases of permanent alopecia as a result of chemotherapy, hair should naturally grow back after chemotherapy hair loss. CG428 lotion gives hair a helping hand during this process through restoring a healthy natural hair cycle.

Is CG428 safe?

No side effects and no drug interactions were reported from CG428 use.
In studies, CG428 was found to be safe and well tolerated.
CG428 contains non-denatured alcohol.
CG428 contains 4 botanical ingredients.

Precautions
Not to be used by subjects already receiving a treatment on the scalp and head area (eg: head and neck radiotherapy, brain radiotherapy).
Do not apply on altered skin such as open wounds, pustules and skin cancer.
Avoid the use of CG428 in case of any hypersensitivity to one of the components.
For external use only. Avoid contact with eyes. Keep out of reach of children. Do not swallow.

How to use CG428?

Apply CG428 every morning and evening. One bottle should last one month.

1 .
Clip the applicator on the bottle. Shake the bottle before each use.

2 .
Spray 5 to 10 times onto the entire scalp, with the applicator in contact with your skin.

3 .
Massage your scalp delicately with fingertips. Do not wash immediately after application.

Hair recovery after chemotherapy hair loss

The fact: On average, first hair regrowth is expected at week 10 after end of chemotherapy treatment ⁽¹⁾.
The CARA study suggests that the period of baldness was reduced by 5 - 16 weeks in subjects using the product ⁽²⁾.
In most volunteers, hair was visible over the whole scalp before week 10 after end of chemotherapy.
Reference data ⁽¹⁾ mention that only a first hair regrowth is usually observed by week 10.
The pictures aside show that volunteers who have started product application soon after chemotherapy initiation never reached total baldness.

The pictures below show how CG428 benefited cancer patients under chemotherapy in comparaison to the typical course of hair loss.

Typical course of hair loss - without CG428

Reference

Chemo treatment

Start of product use

Before start of chemo (or else)

During chemo

Week 0 = End of chemo

Week 2

Week 3

Week 5

Week 6

Week 8

Week 10

Week 12

Week 14

Week 16

V. Kanti et al. (3)

Cyclophosphamide Taxane

End of chemo (week 16 after start of chemo)

Duvic et al. (1)

Maximum hair loss is reached usually 6 weeks after start of chemo

Total balding period from maximum hair loss to first regrowth = 20 weeks

First hair regrowth

CG428 users - CARA study*

CG428 user

Chemo treatment

Start of product use

Before start of chemo (or else)

During chemo

Week 0 = End of chemo

Week 2

Week 3

Week 5

Week 6

Week 8

Week 10

Week 12

Week 14

Week 16

CARA 03

Gemcitabine Docetaxel

-14 weeks before start of chemo

CARA 04

Docetaxel Pertuzumab Trastuzumab T-DM1

At start of chemo

End of chemo

CARA 02

Fluorouracil Epirubicine Cyclophosphamide Paclitaxel

At start of chemo

End of chemo (estimated)

CARA 01

Cyclophosphamide Doxorubicin (Adriamycin) Vincristine

1 week after start of chemo

End of chemo

CARA 05

Cyclophosphamide Docetacel

Week 2

End of chemo

CARA 10

Fluorouracil Epirubicine Cyclophosphamide Paclitaxel

2 weeks before end of chemo

End of chemo

The analysis of the results (pictures) was performed by Legacy Healthcare.
The above pictures represent individual cases. Results may vary between individuals.

References

* Data on file
(1) A randomized trial of minoxidil in chemotherapy-induced alopecia - Duvic, M et al- Journal of the American Academy of Dermatology - Vol.35, No.1, (July 1996), pp. 74-78
(2) CARA - Assessment of the efficacy of CG428 in the recovery from chemotherapy induced alopecia in women (an open label evaluation), Japan 2013
(3) Analysis of quantitative changes in hair growth during treatment with chemotherapy or tamoxifen in patients with breast cancer: a cohort study - V. Kanti, R. Nuwayhid, J. Lindner, K. Hillmann, A. Stroux, N. Bangemann, A. Kleine-Tebbe, U. Blume-Peytavi and N. Garcia Bartels - British Journal of Dermatology (2014) 170, pp643–650

Persistent hair issues resulting from chemotherapy

The fact: 70% of women who had breast cancer adjuvant chemotherapy treatment still complain from persistent hair issues, such as thinning hair, even more than two years after the treatment ⁽¹⁾.

After 3 months of CG428 application, improvement was observed and reported* by 76,2% of volunteers ⁽²⁾.
First improvements were observed and reported as early as 1 month in 33,3 % of the volunteers.
14,3 % of volunteers have not yet observed any improvement after 4 months of application.

Case selection from RELAC study on CG428 efficacy*

Years since end of chemotherapy

Hair issues reported by volunteers

Start of CG428

Month 1

Month 2

Month 3

First improvement reported after

2.4 years

Hair never normalized: Lower volume and thinner hair compared to before chemotherapy.

1 month of CG428 application

4.6 years

Hair did not normalize 4 years after chemotherapy. I have tried several products without results.

1 month of CG428 application

12.5 years

More than 12 years after end of chemotherapy, frontal area never fully recovered.

1 month of CG428 application

1.5 year

19 months after end of chemotherapy the back area didn’t recover properly.

3 months of CG428 application

References

* Data on file
(1) Breast Cancer Society of Japan Annual Meeting, 2013 - Dr Ito, Sogo Hitachi Hospital
(2) RELAC - Assessment of the efficacy of CG428 in the recovery from chemotherapy long term side effects on hair in women (an open label evaluation), Japan 2013

Where do you stand?

I did not start or just started my cancer treatment.

You may experience hair loss after the second chemotherapy session. CG428 users who started product application at this stage reported the quickest hair recovery among CG428 users.

I am currently experiencing chemotherapy hair loss.

CG428 users who started product application during chemotherapy tend to report satisfactory hair recovery after completing chemotherapy treatment.

I have now completed my chemotherapy treatment.

You are on your way to hair recovery. CG428 users who started product application after completing their cancer treatment have reported early beneficial effect on the appearance of their hair.

I had chemo long ago but
I am still unhappy with my hair.

For users complaining from hair thinning, chronic hair loss, and reduced hair volume several years after chemotherapy treatment, CG428 application resulted in improved hair volume and appearance after 2 to 3 months of use.

Apart from rare cases of permanent alopecia as a result of chemotherapy, hair should naturally grow back after chemotherapy hair loss. CG428 lotion gives hair a helping hand during this process through restoring a healthy natural hair cycle. This document contains information related to chemotherapy induced alopecia. Such information is provided for educational purposes only, does not constitute medical advice, and is not meant to be a substitute for the advice of your oncologist or other healthcare professional.

In the studies performed by Legacy Healthcare to assess the efficacy of CG428, volunteers were asked to provide a feedback on their personal experience with the product.
The testimonials below were translated from Japanese to English.

Woman, age 42 Diagnosed with malignant lymphoma Chemotherapy treatment: Cyclophosphamide, Adriamycin, Vincristine Started CG428 one week after beginning of chemotherapy treatment. _____________________________________________________________________________

My Story

As expected I lost a lot of hair during my chemotherapy, but the remaining hair I had was still growing during the treatment, which made me confident. 2 months after the end of chemotherapy, I was already observing many new growing hair. I was glad to see hairs regrow at sides too. At 3 months my parents were really suprised to see my improvement since the previous month ; it was really encouraging to see their reaction. After shampooing my top scalp hair were upright and looked healthy. I really felt confident to go out without a wig or cap after 6 months. At that time I had the equivalent of a very short hair style and I felt relieved.

My pictures

During
Chemotherapy

3 months
after chemotherapy

4 months
after chemotherapy

6 months
after chemotherapy

Woman, age 38 Diagnosed with uterine sarcoma Chemotherapy treatment: Gemcitabine, Docetaxel Started CG428 before the beginning of chemotherapy treatment. _____________________________________________________________________________

My Story

I have started the product before my chemotherapy. I lost most of my hair during the treatment but at my 9th chemotherapy session, I noticed some hair starting to growth. During the 4 next chemotherapy sessions, my hair kept growing. At that time, when I looked at the mirror every morning, I felt my hair was growing each day. The hair at the hairline and the sides seemed to be growing the most. This may be because I apply the lotion from this area. 3 months after my last chemotherapy session I had enough hair to stop using my partial wig and I was able to return to work.

My pictures

9th chemothe-
rapy session

End of chemothe-
rapy (13th session)

3 months
after chemotherapy

Woman, age 47 Never fully recovered her hair after chemotherapy treatment against breast cancer. 4.5 years after her last chemotherapy session, she started CG428. _____________________________________________________________________________

My Story

Even 4 years after cancer, my hair never really came back, especially on the frontal area. I have tried several products that weren’t really efficient and I usually gave up after 1 year. But this time I feel the product is working. After 1 month I could already see a little hair growth. I have been using the product for 2 months already. I look forward to keep improving.

My pictures

Started CG428,
4 years after last
chemotherapy

1 month from
CG428 start

2 months from
CG428 start

Woman, age 66 Never fully recovered her hair after chemotherapy treatment against breast cancer. 12.6 years after her last chemotherapy session, she started CG428. _____________________________________________________________________________

My Story

More than 12 years after my cancer treatment, my hair didn’t regrow on the frontal area.
After 1 month of use, I feel the improvement since less hair is falling. At 2 months, there is still not much volume, but the hair itself is thicker and stronger and I see new hair on the frontal area. I would like to keep on using the product.

My pictures

Started CG428,
12 years after last
chemotherapy

1 month from
CG428 start

2 months from
CG428 start

_____________________________________________________________________________

Share

Your experience can help others.
Please share your story.

yourstory@cg428.com

Questions & Answers

Q. Will I recover my hair after chemotherapy hair loss?
A. Apart from rare cases of permanent alopecia as a result of chemotherapy, hair should naturally grow back after chemotherapy hair loss. CG428 lotion gives hair a helping hand during this process through restoring a healthy natural hair cycle.

Q. Is CG428 efficient?
A. Efficacy of CG428 was assessed through 2 studies. You will find more information on What to expect? section.

Q. What does CG428 contain?
A. CG428 contains a novel patented blend comprised of four botanicals ingredients: Citrus, Cocoa , Guarana, Onion. It also contains water, non-denatured alcohol, fragrance and excipients.

Q. Is CG428 safe?
A. In studies, CG428 was found to be safe and well tolerated.

Q. Will CG428 interact with my chemotherapy treatment?
A. CG428 is a cosmetic lotion. No side effects and no drug interactions were reported from CG428 use.

Q. At which stage of my chemotherapy treatment should I use CG428: before, during or after?
A. You can use CG428 at every stage. You will find more information on Where do you stand? section.

Q. Will CG428 be more effective if I start using it before, during or after my chemotherapy treatment?
A. Based on CARA study results, CG428 users who started product application the earliest reported the quickest hair recovery. Results may vary between individuals and chemotherapy treatments.

Q. Will I lose my hair during chemotherapy and why?
A. On average 65% of chemotherapy patients will experience some degree of hair loss. Chemotherapy drugs attack rapidly growing cancer cells. As a drawback, chemotherapy treatments also attack other rapidly growing cells such as hair follicle cells. ⁽¹⁾

Q. Which chemotherapy treatments cause hair loss?
A. The following chemotherapy treatments are known for causing some degree of hair loss ⁽¹⁾ :

Agents that usually cause hair loss		Agents that sometimes cause hair loss		Agents that rarely cause hair loss
Adriamycin		Amsacrine		Carboplatin
Cyclophosphamide		Bleomycin		Capecitabine
Daunorubicin		Busulphan		Carmustine
Docetaxel		Cytarabine		Cisplatin
Epirubicin		5-Fluorouracil		Fludarabine
Etoposide		Gemcitabine		Methotrexate
Ifosphamide		Lomustine		Mitomycin C
Irinotecan		Melphalan		Mitroxantrone
Paclitaxel		Thiotepa		Procarbazine
Topotecan		Vinblastine		Raltritrexate
Vindesine		Vincristine		6-Marcaptopurine
Vinorelbine				Streptozotocin

Q. Does tamoxifen provoke hair loss?
A. Tamoxifen, a hormonal therapy for breast cancer, is known for inducing hair disorders such as hair thinning and chronic hair loss. ⁽²⁾

Q. How fast will I lose my hair?
A. On average hair usually begins falling out one to three weeks after the start of chemotherapy. It could fall out quickly or gradually ⁽¹⁾.

Q. Will I become completely bald?
A. There is no straightforward answer. The degree of hair loss varies between patients, chemotherapy drugs and doses.

Q. Can I prevent my hair from falling?
A. Cold cap and cooling cap devices are intended to prevent hair from falling during chemotherapy. Their efficacy is variable.
More information is available on www.mayoclinic.org

Q. How long does it take for my hair to grow back after chemotherapy hair loss?
A. Studies indicate that hair is back to its pre-treatment aspect after 6 to 12 months.
More information is available on www.cancer.net

Q. Will my hair grow differently?
A. Change in hair texture and color occurs in 60% of patients ⁽³⁾.



References

(1) Chemotherapy-Induced Alopecia - Ralph M. Trüeb - Department of Dermatology, University Hospital of Zurich - Semin Cutan Med Surg 28:11-14, 2009
(2) Alopecia With Endocrine Therapies in Patients With Cancer - V Saggar, S Wu, M Dickler, M Lacouture - The Oncologist 2013; 18:1126–1134
(3) Pathobiology of chemotherapy-induced hair loss - Vladimir A Botchkarev et al - The Lancet Oncology, Vol 14, Issue 2, February 2013

About you and us

Legacy Healthcare is a biopharmaceutical company based out of Switzerland with offices in the US, Japan and India.

As leaders in Botanical Drug development, our goal is to develop transformative medicines for the treatment of autoimmune and inflammatory diseases, with an immune-sparing mode of action, allowing safe chronic use..

Our research work was published and presented at major scientific congresses worldwide and we were granted several patents globally.

Supportive oncology		Dermatology
SABCS - San Antonio Breast Cancer Symposium - 2014 - USA		Singapore International Conference on Skin Research - 2014 - Singapore
Critical Mass - Young Adult Cancer Alliance - 2014 - USA		AAD - American Academy of Dermatology - 2014 - USA
SIO - Society of Integrative Oncology - 2014 - USA		EADV - European Academy of Dermatology & Venereology - 2014 - Serbia
SIS - World Congress on Breast Cancer - 2014 - USA		WCHR - World Congress for Hair Research - 2014 - Korea
AACR - American Association for Cancer Research - 2014 - USA		EADV - European Academy of Dermatology & Venereology - 2013 - Turkey
MASCC - Multinational Association for Supportive Care in Cancer - 2014- USA		WCHR - World Congress for Hair Research - 2013 - Scotland
AACR - American Association for Cancer Research - 2013 - USA		ISHRS - International Society for Hair Restoration Surgery - 2012 - The Bahamas
MASCC - Multinational Association for Supportive Care in Cancer - 2013- USA		JSCHR - Japan Society of Clinical Hair Restoration - 2012 - Japan
MASCC - Multinational Association for Supportive Care in Cancer - 2015 - Denmark		WCD - World Congress of Dermatology - 2015 - Canada
YSC - Young Survival Coalition - 2015 - USA
NCBC - National Consortium of Breast Centers - 2015 - USA
ONS - Oncology Nursing Society - 2015 - USA
* Oral presentation or Poster presentation

Find more information about Legacy Healthcare on www.legacyhealthcare.ch


Switzerland office
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1066 Epalinges (Lausanne)
+41 21 552 21 70
contact@legacyhealthcare.ch

USA office
1 Stults Drive,
Plainsboro, New Jersey 08536
contact.usa@legacyhealthcare.ch

Japan office
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1-8-3 Shibuya, Shibuya-ku, Tokyo 151-0061
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