Importance: Chemotherapy-induced alopecia as well as nail and cutaneous changes occur in up to 89% of patients receiving taxane-based chemotherapy and are associated with cosmetic concerns, psychosocial distress, and overall morbidity.
Objective: To review the efficacy and safety of interventions to prevent taxane-induced dermatologic adverse events.
Evidence review: PubMed and Scopus databases were systematically reviewed for studies published in the English language from January 1, 1980, to August 13, 2018. Specific search terms included but were not limited to taxane, docetaxel, paclitaxel, prevent, nail, skin, hair, alopecia, and onycholysis. Primary clinical studies that detailed preventive interventions for taxane-induced dermatologic adverse events and that classified results according to a taxane-specific chemotherapy regimen were reviewed and graded according to a 5-point scale, modified from the Oxford Centre for Evidence-based Medicine.
Findings: The 34 original reports that met the inclusion criteria consisted of 6 randomized clinical trials, 4 nonrandomized clinical trials, 18 cohort studies, 3 case-control studies, 1 cross-sectional study, and 2 case reports and involved a total of 5647 unique participants. A total of 22 studies addressed preventive interventions for alopecia associated with taxane use, whereas 12 studies focused on taxane-induced skin and nail changes. Specifically, 20 (95%) of 21 studies supported the use of either a cold cap or a scalp cooling system to reduce alopecia but reported substantial differences in efficacy depending on the chemotherapy regimen. Scalp cooling was generally considered safe by all pertinent studies despite a single report of scalp skin metastasis. Similarly, use of frozen gloves and frozen socks in the prevention of nail and cutaneous hand and foot toxic effects was considered safe in 7 (88%) of 8 studies, although discomfort was common and frostbite was noted in 1 patient. Overall, use of frozen gloves was endorsed by 4 (67%) of 6 studies to prevent nail toxic effects and by 3 (60%) of 5 studies to prevent cutaneous hand changes.
Conclusions and relevance: Scalp hypothermia with cold caps or scalp cooling systems has demonstrated efficacy as a monotherapy in preventing taxane-induced alopecia, and use of frozen gloves and socks has been associated with reduced nail and skin changes. Future studies should establish the routine usage protocols, standard outcome measures, and long-term efficacy and safety for these interventions.