Management of Mitomycin-Induced Hair Loss
Mitomycin does NOT cause hair loss, making this a non-issue for patients receiving this chemotherapy agent. 1
Key Clinical Point
Mitomycin with folinic acid rescue (MTX/FA) is specifically noted for NOT inducing alopecia, which is one of the primary reasons it has been widely adopted as first-line therapy for low-risk gestational trophoblastic neoplasia over actinomycin D. 1
This distinguishes mitomycin from anthracyclines, taxanes, and other chemotherapy agents that commonly cause hair loss in 65% of patients. 2, 3
If Hair Loss Occurs: Rule Out Alternative Causes
If a patient on mitomycin experiences hair loss, investigate other etiologies rather than attributing it to the chemotherapy:
Check thyroid function (TSH, free T4) as thyroid dysfunction commonly causes diffuse hair loss. 4
Measure serum ferritin - levels should be adequate as iron deficiency causes chronic telogen effluvium. 4
Assess vitamin D levels - 70% of women with hair loss have deficiency (<20 ng/mL). 4
Check serum zinc as it serves as a cofactor for hair follicle enzymes. 4
Management If Hair Loss From Other Chemotherapy Agents
For patients receiving hair loss-inducing chemotherapy (NOT mitomycin):
Scalp cooling is the only proven preventive intervention, with 50-65% of patients developing only mild hair loss when used with non-anthracycline regimens. 5
Scalp cooling efficacy is significantly reduced with anthracycline-based regimens (such as doxorubicin/epirubicin combinations). 1, 5
Topical minoxidil 5% twice daily can be initiated after chemotherapy completion to accelerate hair regrowth, shortening the duration of alopecia by approximately 50 days. 6
Minoxidil does NOT prevent hair loss during active chemotherapy but reduces severity and shortens duration. 2, 6