Scalp cooling therapy for chemotherapy-induced hair loss in Asian patients with breast or gynecological cancers – a tertiary institution experience

Abstract Purpose Scalp cooling therapy (SCT) improves chemotherapy induced alopecia (CIA), but there are few published data about its efficacy in an Asian-predominant population. We report our tertiary institution experience of SCT in patients with breast or gynaecological cancers undergoing chemotherapy. Methods The Paxman scalp cooling system was employed for eligible women with breast or gynaecological cancers receiving anthracycline or taxane based chemotherapy. Only patients with Grade (G) 0–1 alopecia by common terminology criteria for adverse events (CTCAE) version 4.0 were eligible initially, but patients with G2 alopecia were later included in the study. SCT was performed at each chemotherapy cycle, commencing 30 minutes prior to and continuing up to 90 minutes after completion of the drug infusion. Patients were assessed at the start and end of each session for hair preservation (defined as G0–2 alopecia) and comfort level of SCT (rated on a 5-point visual scale). The primary end point was success of hair preservation or hair regrowth after completion of all cycles of chemotherapy. Results 83 participants were enrolled over a period of 18 months from December 2017 to October 2019, with a total of 510 scalp cooling cycles performed. 94.0% (n = 78) of patients reported a comfort score of 3 (indicating that procedure was comfortable) and above upon a 5-point visual scale. Patients receiving weekly paclitaxel had highest success in hair preservation at 76.7% (23/30 patients), with a lower rate of hair preservation observed for the 3-weekly paclitaxel regimen (50%, 2/4 patients). In contrast, only 1 patient (5.3%, 1/19 patients) who underwent chemotherapy with anthracycline and cyclophosphamide achieved hair preservation. Conclusion SCT is well tolerated in an Asian predominant population. Among women with breast or gynaecological cancers in Singapore receiving taxane and/or anthracycline based chemotherapy, those who underwent SCT were about 50% more likely to achieve hair preservation or hair regrowth, as compared to historical controls.