Impact of chemotherapy regimen and sequence on the effectiveness of scalp cooling for alopecia prevention.

Purpose: Scalp cooling (SC) is the most reliable method for the prevention of chemotherapy-induced alopecia. However, it remains unclear if its effectiveness is related to the chemotherapy regimen, sequence, and frequency. This study aims to evaluate SC performance among breast cancer patients who received different chemotherapy regimens.

Methods: The medical records of all consecutive patients undergoing curative-intent chemotherapy and receiving at least one SC session using the DigniCap® System from 2016-2020 in a private Mexican hospital were retrospectively reviewed. SC effectiveness according to chemotherapy regimen was analyzed using descriptive statistics. Successful alopecia prevention was defined as grade 0-1 alopecia (< 50% hair loss not requiring the use of a wig or headpiece) according to the Common Terminology Criteria for Adverse Events version 4.0.

Results: SC adequately prevented alopecia in 56/76 (74%) patients. All 12/12 (100%) and 15/17 (88%) patients receiving paclitaxel-only and docetaxel-based chemotherapy, respectively, had effective hair preservation. SC was successful in 7/16 (44%) patients when sequential chemotherapy started with anthracyclines and 22/30 (73%) when paclitaxel was administered upfront. Considering dose-dense regimens, 9/15 (60%) had satisfactory hair retention, and chemotherapy sequence was not clearly related to SC success.

Conclusion: SC was highly effective in preventing alopecia, particularly with taxane-based regimens. Notably, better outcomes were observed when sequential chemotherapy started with taxanes followed by anthracyclines than when the inverse order was administered, suggesting that the chemotherapy sequence, rather than chemotherapeutic agents per se, might have a more significant impact on the effectiveness of SC for the prevention of alopecia.