Comparable effectiveness of 45- and 20-min post-infusion scalp cooling time in preventing paclitaxel-induced alopecia — a randomized controlled trial

Abstract

Purpose Scalp cooling can prevent chemotherapy-induced alopecia (CIA). Previously, the post-infusion cooling time (PICT) could be successfully reduced in docetaxel-treated patients from 90 to 45 and 20 min. Therefore, it seems plausible that the PICT can be shortened for paclitaxel-treated patients as well. Methods Patients treated with weekly paclitaxel were included in this multi-centre trial and randomly assigned to a PICT of 45 or 20 min. The results were compared to a standard PICT of 90 min, derived from prospective collected data from the Dutch Scalp Cooling Registry. The primary endpoint was the percentage of patients who decide to not wear a wig or head covering. Secondary endpoints were the degree of CIA assessed with the Dean scale for assessment of hair loss; alopecia graded according to NCI CTC toxicity version 4.03 (CTCAE4.03); tolerance of scalp cooling and perceived distress of CIA. Results Ninety-one patients were enrolled in this study; 74 patients were evaluable for hair loss. Hair preservation was successful in 27 patients (75%) with a PICT of 45 min and in 31 patients (82%) with a PICT of 20 min. There was no difference in success rate with the standard PICT of 90 min (85%, p = 0.29). Similar success rates were seen when using the Dean scale and CTCAE assessment, with no differences between groups (p = 0.12 and p = 0.38). Conclusions A 20 min PICT is as effective as 45 and 90 min to prevent weekly paclitaxel-induced alopecia and should be the new standard of care. Trial register ClinicalTrials.gov Identifier: NCT03266185.

Crioterapia no Manejo da Alopecia Induzida por Quimioterapia: Revisão Integrativa

“…Diante dessa problemática, visando uma redução no tempo de permanência do paciente e no descongestionamento das salas de quimioterapia, tem-se estudado a diminuição do resfriamento pós-infusão em pacientes em tratamento com taxanos de 95 minutos para 20 minutos. Em geral, não foi identificada diferença significativa na qualidade do resultado decorrente da redução do tempo e, além dos benefícios já citados, essa redução do tempo de exposição ao resfriamento de couro cabeludo pode ajudar a diminuir as chances de o paciente desenvolver uma lesão hipotérmica ou vir a desistir do uso da técnica 14,23 .…”

Natural Taxanes: From Plant Composition to Human Pharmacology and Toxicity

“…Cryotherapy can be used to prevent toxic manifestations on the skin and nails, having a good preventive effect and minimal side effects [ 108 ]. Lugtenberg et al carried out research on the effect of cryotherapy on the prevention of alopecia during the administration of paclitaxel in monotherapy, while they found that cooling the head, which begins before the administration of paclitaxel and continues 20–45 min after administration, was effective and led to the prevention of severe alopecia in 78% of cases [ 142 ].…”