Scalp Hypothermia Minimizes Alopecia in Breast Cancer Patients Receiving Non-Anthracycline Adjuvant Chemotherapy.
Authors: S. Wills, A. Ravipati, M. Nguyen, Z. Dana, I. Jaiyesimi, J. Margolis, D. Decker
Journal: Cancer Research (2009)

Abstract Background: Chemotherapy induced alopecia (CIA) is considered the most distressing side effect of chemotherapy for breast cancer patients. Scalp hypothermia offers hope to minimize chemotherapy induced alopecia (CIA) for breast cancer patients. We present data from a pilot study of scalp hypothermia with the Penguin Cold Cap System™ in patients receiving a combination chemotherapy regimen. Patients and Methods: Stage I-IIIC breast cancer patients, receiving adjuvant chemotherapy regimens with or without (A) were consented. Standard dose regimens included doxorubicin-cyclophosphamide (AC) x 4 cycles, dose dense, doxorubicin-cyclophosphamide followed by taxol (AC-T) x 8 cycles, taxotere-doxorubicin-cyclophosphamide (TAC) x 6 cycles, taxotere-cyclophosphamide (TC) x 4 cycles and taxotere-carboplatnium-trastuzumab (TCH) x 6 cycles. Photos were taken before and with each cycle and 3 weeks post chemotherapy, Dean's alopecia scale was used for grading. Caps were cooled to 8oC. Caps 1-2 were 20 minutes each prior to infusion, following caps were changed q 30 minutes throughout chemotherapy and for 3 hours post-chemotherapy. Results: See tables 1 and 2 for patient data. We enrolled 34 patients (22 (A) containing; 12 non (A) containing) after informed consent. Of patients withdrawn, 1 patient (AC-T) had metastatic disease at the time of registration and did not start scalp hypothermia,1 patient (TC) had scalp discoloration; 2 patients (AC and TAC) withdrew due to discomfort of cooling; 1 patient (TC) withdrew prior to start of therapy due to fear of discomfort and 1 patient (AC) was withdrawn for coloring hair at time of treatment. The mean percent of CIA in the (A) containing group was 52% (SD: 17 CI: 40-70) and the mean percent CIA in non (A) containing group was 25% (SD: 36 CI: 5-100). A comparison of the means yielded a p-value of 0.0003 in favor of non (A) containing regimens. Of the 12 patients in the non (A) containing regimen 83% (3 TCH, 7 TC) did not require a prostheses and of the patients receiving an (A) containing regimen 47% (8 AC) did not require a prostheses. For those patients who completed scalp hypothermia through chemotherapy, the median CIA for TC and TCH combined was 10% hair loss (5,25) and for AC, AC-T and TAC combined was 50% hair loss (45,70). Discussion: All patients who received TAC or AC-T had grade 4 CIA and needed a hair prostheses. Most AC patients preserved some of their hair. Hair thinning was even and not patchy in this group and most had no need for prostheses. Patients in the TC or TCH group, who were able to complete the scalp hypothermia therapy, retained 90% or better, of their hair and there was no need for prostheses in these groups. We found the scalp hypothermia technique used here reduces hair loss in AC patients and offers the possibility of CIA prevention for women with breast cancer receiving TC or TCH.Table 1. Data for all enrolled patientsRegimenEnrolledWithdrewCompletedAC1028AC-T716TAC514TC927TCH3-3 Table 2. Deans alopecia scale for all enrolled patientsRegimenGrade1 Excellent &amp;lt;25%Grade 2 Good 25-50%Grade 3 Moderate 50-75%Grade 4 Poor &amp;gt;75%AC2422AC-T---7TAC---5TC7--2TCH3--- Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5040.