Evaluation of Prevention Interventions for Taxane-Induced Dermatologic Adverse Events

Abstract

IMPORTANCE Chemotherapy-induced alopecia as well as nail and cutaneous changes occur in up to 89% of patients receiving taxane-based chemotherapy and are associated with cosmetic concerns, psychosocial distress, and overall morbidity.OBJECTIVE To review the efficacy and safety of interventions to prevent taxane-induced dermatologic adverse events.EVIDENCE REVIEW PubMed and Scopus databases were systematically reviewed for studies published in the English language from January 1, 1980, to August 13, 2018. Specific search terms included but were not limited to taxane, docetaxel, paclitaxel, prevent, nail, skin, hair, alopecia, and onycholysis. Primary clinical studies that detailed preventive interventions for taxane-induced dermatologic adverse events and that classified results according to a taxane-specific chemotherapy regimen were reviewed and graded according to a 5-point scale, modified from the Oxford Centre for Evidence-based Medicine.FINDINGS The 34 original reports that met the inclusion criteria consisted of 6 randomized clinical trials, 4 nonrandomized clinical trials, 18 cohort studies, 3 case-control studies, 1 cross-sectional study, and 2 case reports and involved a total of 5647 unique participants. A total of 22 studies addressed preventive interventions for alopecia associated with taxane use, whereas 12 studies focused on taxane-induced skin and nail changes. Specifically, 20 (95%) of 21 studies supported the use of either a cold cap or a scalp cooling system to reduce alopecia but reported substantial differences in efficacy depending on the chemotherapy regimen. Scalp cooling was generally considered safe by all pertinent studies despite a single report of scalp skin metastasis. Similarly, use of frozen gloves and frozen socks in the prevention of nail and cutaneous hand and foot toxic effects was considered safe in 7 (88%) of 8 studies, although discomfort was common and frostbite was noted in 1 patient. Overall, use of frozen gloves was endorsed by 4 (67%) of 6 studies to prevent nail toxic effects and by 3 (60%) of 5 studies to prevent cutaneous hand changes.CONCLUSIONS AND RELEVANCE Scalp hypothermia with cold caps or scalp cooling systems has demonstrated efficacy as a monotherapy in preventing taxane-induced alopecia, and use of frozen gloves and socks has been associated with reduced nail and skin changes. Future studies should establish the routine usage protocols, standard outcome measures, and long-term efficacy and safety for these interventions.

Plant Extracts as Possible Agents for Sequela of Cancer Therapies and Cachexia

“…Oxaliplatin can bring about neurotoxicity through alternation of blood brain barrier (BBB), thrombocytopenia and intestinal dysfunction [ 55 , 56 , 57 ]. Taxane-based chemotherapy induces alopecia as well as nail and cutaneous changes [ 58 ] and TS-1 can induce myelosuppression and leukopenia [ 59 ]. The main side effect of vincristine includes peripheral neuropathy and inappropriate secretion of antidiuretic hormone (ADH) [ 60 , 61 ].…”

Dermatologic conditions in women receiving systemic cancer therapy

“…Localized cryotherapy with the use of frozen gloves and socks (FGS) during treatment infusion has demonstrated efficacy in phase 2 trials, where the treated limb had significantly less nail toxicity than the other control limb (Sakurai et al, 2009, Scotté et al, 2005, Scotté et al, 2008). A review of existing trials noted that four of six established studies supported FGS as an effective preventive strategy for chemotherapy-induced nail toxicities (Can et al, 2012, Marks et al, 2018, Sakurai et al, 2009, Scotté et al, 2005, Scotté et al, 2008). The potential adverse effects of FGS include pain, discomfort, and frostbite (Marks et al, 2018).…”

“…A review of existing trials noted that four of six established studies supported FGS as an effective preventive strategy for chemotherapy-induced nail toxicities (Can et al, 2012, Marks et al, 2018, Sakurai et al, 2009, Scotté et al, 2005, Scotté et al, 2008). The potential adverse effects of FGS include pain, discomfort, and frostbite (Marks et al, 2018). Other therapies that have been investigated with promising results include the use of hydrating nail solution, which significantly reduced the incidence of onycholysis in a RCT of patients with breast cancer (Kim et al, 2017), and polyphenol-rich nail bed balm, which reduced the incidence of onycholysis in a double-blind RCT in the United Kingdom (Thomas et al, 2018).…”

“…Gentle nail care is essential in the prevention of targeted therapy–induced paronychia and includes regular nail trimming, avoidance of trauma to the nails (e.g., biting and manicuring), and avoidance of undue pressure to the nailfolds by wearing properly fitting shoes (Gilbar et al, 2009, Marks et al, 2018). Nail lacquers (e.g., hydroxypropyl chitosan and polyureaurethan 16%) have been shown to prevent nail dehydration and improve nail strength (Guggina et al, 2017).…”

LC478, a Novel Di-Substituted Adamantyl Derivative, Enhances the Oral Bioavailability of Docetaxel in Rats

“…Docetaxel, a second-generation taxane, has significant and broad anti-tumor activities against breast, ovary, prostate, non-small cell lung, and gastric cancers [1,2]. An intravenous formulation of docetaxel that is currently marketed (Taxotere ® , Sanofi SA, Paris, France) shows several drawbacks including non-ionic surfactant-induced severe hypersensitivity reaction [3], skin damage, extravasation catheter-related infection, and potential thrombosis by intravenous injection [4,5]. Oral docetaxel chemotherapy is a desired alternative regimen [5,6] in terms of administration convenience, better patient compliance, and prolonged systemic exposure profile with less fluctuation [7,8,9].…”