Prevention of Chemotherapy-Induced Alopecia

Shin H. et al. Efficacy of Interventions for Prevention of Chemotherapy-Induced Alopecia: A Systematic Review and Meta-Analysis. Int J Cancer. 2015 Mar 1;136(5):E442-54

In brief

Chemotherapy‐induced alopecia is a common and stressful adverse effect of chemotherapy. A meta-analysis of 17 clinical trials involving 1,098 participants reported that, among several methods used to prevent such hair loss, scalp cooling is the most efficient. Scalp cooling is well tolerated and should be the recommended intervention for prevention of chemotherapy‐induced alopecia in patients with breast cancer undergoing chemotherapy regimens.

Introduction

Few weeks after the first cycle of chemotherapy, many patients experience stressful hair-related adverse effects such as changes in hair color, textures, growth rate even after regrowth of hairs or chemotherapy‐induced alopecia (CIA).

The occurrence and severity of CIA is dependent on the nature of the cytotoxic chemotherapeutic agent, the dose, administration schedule and other protocols. The hair shedding caused by cytotoxic chemotherapeutics is called anagen effluvium.

Several methods have been used for the prevention of CIA : scalp cooling, scalp compression with tourniquet, topical minoxidil, melatonin. However, there is no clinical data on comparisons of these different measures.

Meta-analysis

A literature search in three databases (PubMed, EMBASE, the CENTRAL) and a study selection were performed and a total of 691 articles were identified and only 17 trials were included in the meta‐analysis and analyzed to calculate the relative risks and 95% confidential intervals were calculated for efficacy of CIA prevention. These 17 trials involved a total of 1,098 participants with 616 in the intervention groups and 482 in the control groups (Figure 1).

Figure 1. Efficacy of prevention for chemotherapy‐induced alopecia development in the random‐effects meta‐analysis of prospective randomized controlled trials and controlled clinical trials. RR indicates relative risk; CI, Confidence Interval; Horizontal lines, 95% CIs; gray boxes, the weight of each study; Diamond data markers represent each overall RR and 95% CI for the outcome of interest.

Scalp cooling is the most effective preventive method

Scalp cooling consists in wearing a cooling cap, made with soft thermoabsorbent material. The cooling cap is fully refrigerated below 0°C before application and applied to the scalp 10–30 min before chemotherapeutic agent administration until 0–90 min post‐treatment.

Scalp cooling was the most common and effective preventive method and it significantly reduced the development of CIA (one-third reduction of relative risk), in both randomized controlled and controlled clinical trials, regardless of the gender of study population, the underlying cancer, the year of publication, and the country where the study was conducted.

Scalp cooling significantly prevented CIA induced by doxorubicin‐ and epirubicin‐containing regimens, docetaxel, and the various combination regimens, except for combination therapy with cyclophosphamide, methotrexate and 5‐fluorouracil.

Most of the adverse events were not serious and included intolerable coldness and headaches. Contraindication are cold sensitivity, cold agglutinin disease, cryoglobulinemia and cryofibrinogenemia.

Other methods

Neither scalp compression, topical 2% minoxidil nor Panicum miliaceum (a phytotherapeutic agent) significantly reduced the development of CIA.

Scalp cooling combined with compression significantly reduced the development of CIA. Scalp compression with tourniquets is involves an inflatable tourniquet used to reduce the blood supply (from the external carotid artery) to the scalp during the time of peak plasma concentration of chemotherapeutics.

Conclusion

Scalp cooling prevents chemotherapy‐induced alopecia in patients receiving chemotherapy. It is well tolerated and should be the recommended intervention for prevention of chemotherapy‐induced alopecia in patients with breast cancer undergoing doxorubicin, epirubicin or docetaxel‐containing chemotherapy regimens.

Reference

Shin H. et al. Efficacy of Interventions for Prevention of Chemotherapy-Induced Alopecia: A Systematic Review and Meta-Analysis. Int J Cancer. 2015 Mar 1;136(5):E442-54