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Impact of chemotherapy regimen and sequence on the effectiveness of scalp cooling for alopecia prevention

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Abstract

Purpose

Scalp cooling (SC) is the most reliable method for the prevention of chemotherapy-induced alopecia. However, it remains unclear if its effectiveness is related to the chemotherapy regimen, sequence, and frequency. This study aims to evaluate SC performance among breast cancer patients who received different chemotherapy regimens.

Methods

The medical records of all consecutive patients undergoing curative-intent chemotherapy and receiving at least one SC session using the DigniCap® System from 2016–2020 in a private Mexican hospital were retrospectively reviewed. SC effectiveness according to chemotherapy regimen was analyzed using descriptive statistics. Successful alopecia prevention was defined as grade 0–1 alopecia (< 50% hair loss not requiring the use of a wig or headpiece) according to the Common Terminology Criteria for Adverse Events version 4.0.

Results

SC adequately prevented alopecia in 56/76 (74%) patients. All 12/12 (100%) and 15/17 (88%) patients receiving paclitaxel-only and docetaxel-based chemotherapy, respectively, had effective hair preservation. SC was successful in 7/16 (44%) patients when sequential chemotherapy started with anthracyclines and 22/30 (73%) when paclitaxel was administered upfront. Considering dose-dense regimens, 9/15 (60%) had satisfactory hair retention, and chemotherapy sequence was not clearly related to SC success.

Conclusion

SC was highly effective in preventing alopecia, particularly with taxane-based regimens. Notably, better outcomes were observed when sequential chemotherapy started with taxanes followed by anthracyclines than when the inverse order was administered, suggesting that the chemotherapy sequence, rather than chemotherapeutic agents per se, might have a more significant impact on the effectiveness of SC for the prevention of alopecia.

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Data availability

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This research did not receive any grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Cynthia Villarreal-Garza and Fernanda Mesa-Chavez have contributed equally to this work and are both to be considered first authors.

Authors and Affiliations

  1. Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Batallon de San Patricio 112, Real de San Agustin, 66278, San Pedro Garza Garcia, Nuevo Leon, Mexico

    Cynthia Villarreal-Garza, Fernanda Mesa-Chavez, Ma ria Alejandra Garza-Ledezma, Omar Peña-Curiel, Bertha Alejandra Martinez-Cannon, Mauricio Canavati-Marcos & Servando Cardona-Huerta

Authors
  1. Cynthia Villarreal-Garza
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  2. Fernanda Mesa-Chavez
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  3. Ma ria Alejandra Garza-Ledezma
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  4. Omar Peña-Curiel
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  5. Bertha Alejandra Martinez-Cannon
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  6. Mauricio Canavati-Marcos
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  7. Servando Cardona-Huerta
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Contributions

CV-G, MC-M, and SC-H contributed to the study conception and design. Material preparation, data collection, and analysis were performed by FM-C, MAG-L, OP-C, and BAM-C. The first draft of the manuscript was written by CV-G and FM-C, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Cynthia Villarreal-Garza.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and national regulations and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

A waiver of informed consent was provided by the Ethics and Research Committees of the Institutional Review Board of Escuela de Medicina del Tecnologico de Monterrey given that this study involves no more than minimal risk to the subjects considering that it represents a retrospective record review in which all analyzed data were collected from patients’ existing medical files, does not include information that could identify the subjects and does not involve the implementation of any procedures or the deliberate modification of any physiological, psychological, or social variables of the studied population.

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Villarreal-Garza, C., Mesa-Chavez, F., Garza-Ledezma, M.r.A. et al. Impact of chemotherapy regimen and sequence on the effectiveness of scalp cooling for alopecia prevention. Breast Cancer Res Treat 185, 453–458 (2021). https://doi.org/10.1007/s10549-020-05968-w

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  • DOI: https://doi.org/10.1007/s10549-020-05968-w

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