Sensor-controlled scalp cooling (SCSC) to prevent chemotherapy-induced alopecia (CIA) in patients (pts) with primary breast cancer (PBC) is approved by the FDA. However, SCSC isl infrequently used in many countries due to concerns regarding both safety and feasibility. This retrospective analysis sought to obtain more detailed information about the effectiveness and safety of SCSC using the Paxman system (Paxman, Huddersfield, UK) in PBC pts exposed to neoadjuvant (NACT) or adjuvant Ctx (ACT) in the clinical routine.
79 pts were identified from our database: NACT, 41 (51.9%); ACT, 38 (48.1%); dose-dense (dd) Ctx, 56 (70.9%); non-dd Ctx 23 (29.1%); premenopausal, 44 (55.7%); postmenopausal, 35 (44.3%). The following Ctx regimens were used: anthracycline-based (A), 1 (1.3%); taxane-based (T), 21 (26.6%); AT-based, 55 (69.6%); non AT-based, 2 (2.5%). Pts were subjected to SCSC during each Ctx cycle. CIA was quantified using the Dean score (DS) determined 3 wks after the last Ctx cycle. Data were analyzed regarding the SCSC completion rate, quality of hair preservation (success: DS 0-2, failure: DS 3-4), reasons of SCSC discontinuation, and toxicity. Moreover, the following parameters were investigated in regard to the success of SCSC: menopausal status, NACT vs ACT, dd Ctx vs non-dd Ctx, AT-based Ctx vs A-/T- or non-AT-based Ctx.
55 pts (69.6%) completed SCSC with 36 (45.6%) showing complete (DS 0), and 19 (22.8%) showing partial success (DS 1-2). 24 pts (30.4%) discontinued SCSC with CIA seen in 18 pts (22.8%). Headache and local discomfort (“feeling cold”) were reported in 4 pts (5.1%) each. Side effects were all not severe and resolved quickly after cessation of SCSC. SCSC was equally effective in all analyzed subgroups. The relative risk (RR) to experience CIA was 1.11 (CI: 0.82-1.54) for post- vs premenopausal pts; 1.11 (CI: 0.83-1.53) for ACT vs NACT; 1.31 (CI: 0.96-1.72) for AT vs other Ctx protocols, and 0.99 (CI 0.72-1.43) for dd Ctx vs non-dd Ctx.
In our study, SCSC was safe and effective to prevent CIA in PBC pts. The success rate in our study is in good agreement to previous randomized trials of SCSC in PBC arguing in favor that SCSC is a valuable supportive treatment in the clinical routine.
Clinical trial identification
Legal entity responsible for the study
Christian M. Kurbacher
All authors have declared no conflicts of interest.