Effect of Scalp Cooling on the Pharmacokinetics of Paclitaxel.

Leni Van Doorn,Esther Oomen-De Hoop,Ron H J Mathijssen,Agnes Jager,Wendy M Van Der Deure,Eman Ibrahim,Mandy M Van Rosmalen,Lena E Friberg,Paola Veenstra,Ingrid A Boere,Sophie M Wijngaard,Robert Porrazzo,Peter De Bruijn,Stijn L W Koolen

doi:10.3390/cancers13153915

Leni Van Doorn, Esther Oomen-De Hoop + Show 12 more

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https://doi.org/10.3390/cancers13153915

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Abstract

Simple SummaryThis study investigated the correlation between scalp cooling used to prevent chemotherapy-induced alopecia and the pharmacokinetics of paclitaxel in female cancer patients with a solid tumor. In a prospective cohort study, 14 patients who were treated with weekly paclitaxel and scalp cooling were able to undergo pharmacokinetic sampling of paclitaxel during one cycle of treatment. In comparison to a control cohort of 24 patients treated with weekly paclitaxel without scalp cooling, our data showed that scalp cooling used concomitantly with one course of paclitaxel did not reduce or increase the clearance of paclitaxel. Therefore, it is unlikely that scalp cooling influences paclitaxel efficacy or toxicity. Finally, despite scalp cooling, half of the patients in our study developed a form of hair loss. Importantly, neither an association with difference in paclitaxel clearance nor change in hair loss was found.Chemotherapy-induced alopecia (CIA), a side effect with high impact, can be prevented by cooling the scalp during the administration of some cytotoxic drugs. However, the effects of this prolonged scalp cooling on the pharmacokinetics of chemotherapy have never been investigated. In this study, we compared the pharmacokinetics of the widely used chemotherapeutic agent paclitaxel (weekly dose of 80–100 mg/m2) in female patients with solid tumors using concomitant scalp cooling (n = 14) or not (n = 24). Blood samples were collected in all patients for pharmacokinetic analyses up to 6 h after one course of paclitaxel administration. The primary endpoint was the clearance (L/h) of paclitaxel. Paclitaxel clearance—expressed as relative difference in geometric means—was 6.8% (90% CI: −16.7% to 4.4%) lower when paclitaxel was administered with concomitant scalp cooling versus paclitaxel infusions without scalp cooling. Within the subgroup of patients using scalp cooling, paclitaxel clearance was not statistically significantly different between patients with CIA (alopecia grade 1 or 2) and those without CIA. Hence, scalp cooling did not negatively influence the clearance of paclitaxel treatment.

Highlights

Chemotherapy-induced alopecia (CIA) is a commonly feared side effect of systemic anti-cancer treatment [1]
Between January 2016 and December 2020, a total of 21 female patients with solid tumors were enrolled in the scalp cooling study
14 patients were evaluable for the main analyses. These patients were treated in accordance with the study protocol with scalp cooling during one cycle of paclitaxel treatment dosed at 80 mg/m2 (36%) or 90 mg/m2 (64%) depending on the indication

Summary

Introduction

Chemotherapy-induced alopecia (CIA) is a commonly feared side effect of systemic anti-cancer treatment [1]. It can affect a patient’s quality of life dramatically and is one of the most distressing and adverse aspects of anti-cancer treatment, for women [2]. Deep scalp cooling (4 ◦ C), lasting for 20–45 min before, continued during and lasting for up to 150 min after chemotherapy infusion, may potentially lead to a temperature reduction of the whole body. This drop in body temperature may lead to alterations in pharmacokinetics [7].

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