Persistent major alopecia following adjuvant docetaxel for breast cancer: incidence, characteristics, and prevention with scalp cooling

Abstract

Background: Persistent alopecia (PA) after docetaxel has been recently described. The aim of our study is to establish the incidence and characteristics of PA following adjuvant docetaxel for breast cancer (BC) and to test the ability of scalp cooling in prevention.

Patients and methods: BC patients receiving adjuvant chemotherapy followed or not by endocrine therapy (and a control group receiving only endocrine therapy) were interviewed in a single institution at 1.5 to 5 years following primary diagnosis searching for PA. A confirmatory prevalence study was later performed in other two institutions. Finally, a prevention study using prophylactic scalp cooling (PSC) with ELASTO-GEL hypothermia caps in patients receiving adjuvant docetaxel was performed.

Results: In the initial prevalence study (492 patients), minor forms of PA (grade 1) were recorded with all chemotherapy regimens and aromatase inhibitors. Patients receiving docetaxel regimens at cumulative dose (CD) ≥ 400 mmg/m2 presented a significantly higher prevalence of grades 1 PA (33-52%) and 2 PA (5-12%). Prevalence of grade 2 PA with docetaxel CD ≥ 400 mmg/m2 was confirmed in two other institutions. Overall, grade 2 PA was seen in 10.06% (95% CI 7.36-13.61) of 358 patients with docetaxel regimens reaching CD ≥ 400 mmg/m2, but not in patients with lower docetaxel CD, other chemotherapy regimens, or endocrine therapy alone. In prevention trial, no grade 2 PA occurred among 116 patients receiving adjuvant docetaxel (≥ 400 mmg/m2) and PSC followed-up after a 96 months median time. PSC was well tolerated. No scalp relapses were seen among 30 patients (22% of all inclusions) having disease relapse.

Conclusion: Adjuvant treatment with docetaxel (CD ≥ 400 mmg/m2) is associated with a significant rate of grade 2 PA, leading to wearing a wig, in around 10% of patients. This toxicity was completely prevented with scalp cooling. Clinical Trial Reference: NCT00515762.

Keywords: Alopecia; Breast cancer; Docetaxel; Scalp cooling.

Conflict of interest statement

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The authors declare that the experiments comply with the current laws of the country in which it was performed.

Figures

Fig. 1

Persistent alopecia (PA) in patients treated with chemotherapy or endocrine therapy in one of the institutions (HCSC). TAM: tamoxifen; AI: aromatase inhibitors (no chemotherapy); FAC/FEC: 5-fluorouracil,doxorubicin or epirubicin, cyclophosphamide × 6 cycles; ANT-PACL: anthracyclines × 4 cycles followed by paclitaxel; ET-CAP: epirubicin plus docetaxel 75 mg/m2 × 4 cycles, followed by capecitabine; TAC: docetaxel 75 mg/m2, doxorubicin, cyclophosphamide × 6 cycles; ANT-DOCE: anthracyclines × 4 cycles followed by docetaxel 100 mg/m2 × 4 cycles; Around two-thirds of the patients treated with adjuvant chemotherapy received endocrine therapy with tamoxifen, aromatase inhibitors, or both afterwards

Fig. 2

Persistent alopecina after 46 to 120 months following the conclusion of docetaxel chemotherapy. Panels a–i: Grade 2 Persistent Alopecia. Panels j–l: Grade 1 Persistent Alopecia (with permission from the patients)