Chemotherapy-induced Alopecia Research Articles

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

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. 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 30min prior to and continuing up to 90min 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. Eighty-three patients were enrolled over a period of 18months 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 and above, indicating that the procedure was comfortable, 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. SCT is well tolerated in an Asian-predominant population. Among women with breast or gynaecological cancers 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.

Comparative Study on Enhanced Skin Permeation Efficiency of Phenylephrine via Novel Lipid Vesicles: A Promising Approach in Preventing Chemotherapy-Induced Alopecia Management.

Chemotherapy-induced alopecia (CIA) significantly impacts patients' emotional and psychological well-being and treatment regimen. Phenylephrine, a topical vasoconstrictor, can potentially reduce hair loss by limiting chemotherapy drug delivery to hair follicles. However, effective delivery of Phenylephrine through the skin remains challenging. This study investigates lipid vesicles as delivery vehicles to enhance Phenylephrine's skin permeation and sustained release due to their biocompatibility and encapsulation capabilities. This study aimed to formulate and compare different lipid vesicles of Phenylephrine HCl for enhanced permeation through the skin for deep dermal delivery with sustained release of the drug so as to achieve local vasoconstriction. Phenylephrine-loaded ethosomes, invasomes, and transfersomes were prepared and characterized for particle size (PS), polydispersity index (PDI), and entrapment efficiency (EE %). These lipid vesicles were incorporated into hydrogels to facilitate sustained drug release to deep dermal layers where they could target local vasculature and cause vasoconstriction. The prepared vesicular gels were evaluated for various permeation parameters. The entrapment efficiencies of the developed vesicles ranged from 49.51 ± 3.25% to 69.09 ± 2.32%, with vesicle sizes ranging from 162.5 ± 5.21 nm to 321.32 ± 3.75 nm. Statistical analysis revealed significantly higher flux values (Jss, μg/cm2 h) of 0.6251, 0.6314, and 0.4075 for invasomal gel, ethosomal gel, and transfersomal gel, respectively, compared to plain gel (0.1254) (p < 0.005). The enhancement factors were 4.9848, 5.0350, and 3.2496 for invasomal gel, ethosomal gel, and transfersomal gel, respectively, indicating superior permeation abilities of ethosomal and invasomal formulations. The results demonstrate that ethosomal and invasomal formulations were efficient in delivering the drug to deep dermal layers of skin in a sustained manner. These findings suggest that these Lipidic vesicles would be able to target the local vasoconstrictor to vasculature, causing reduced hair loss by limiting chemotherapy drug delivery to hair follicles and managing chemotherapy-induced alopecia.

Low-Level Laser and LED Therapy in Alopecia: A Systematic Review and Meta-Analysis.

Low-level laser/LED therapy (LLLT) has been described as a treatment option for alopecia, but no study has comprehensively reviewed its efficacy in multiple alopecia types. To review and evaluate LLLT for various alopecia types. A systematic search of PubMed/MEDLINE, Embase, and CENTRAL was conducted to identify studies assessing the effect of LLLT on patients diagnosed with alopecia. Prespecified outcome measure was the change in hair density. Meta-analysis was performed to calculate the standardized mean difference in hair density before and after LLLT compared with placebo. Thirty-eight studies were included that described 3,098 patients with androgenetic alopecia (2,930/3,098), scarring alopecia (49/3,098), alopecia areata (50/3,098), telogen effluvium (17/3,098), and chemotherapy-induced alopecia (32/3,098). The mean change in hair density increased significantly in androgenetic alopecia patients after LLLT for 4 to 26 weeks compared with placebo (<20 weeks: SMD = 1.14; 95% CI [0.51-1.78]; p = .000; I2 = 88.26%; >20 weeks: SMD = 1.44; 95% CI [0.97-1.91]; p = .000; I2 = 80.81%). Change in hair density was reported in 5 studies evaluating other alopecia types; however, statistical information was insufficient for meta-analysis. LLLT is a promising treatment option for patients with androgenetic alopecia, but future studies are needed to better understand its efficacy in other alopecia types.

Results of the Dutch scalp cooling registry in 7424 patients: analysis of determinants for scalp cooling efficacy.

Chemotherapy-induced alopecia is a common consequence of cancer treatment with a high psychological impact on patients and can be prevented by scalp cooling (SC). With this multi-center patient series, we examined the results for multiple currently used chemotherapy regimens to offer an audit into the real-world determinants of SC efficacy. The Dutch Scalp Cooling Registry collected data on 7424 scalp-cooled patients in 68 Dutch hospitals. Nurses and patients completed questionnaires on patient characteristics, chemotherapy, and SC protocol. Patient-reported primary outcomes at the start of the final SC session included head cover (HC) (eg, wig/scarf) use (yes/no) as a surrogate for patient satisfaction with SC and WHO score for alopecia (0 = no hair loss up to 3 = total alopecia) as a measure of scalp cooling success. Exhaustive logistic regression analysis stratified by chemotherapy regimen was implemented to examine characteristics and interactions associated with the SC result. Overall, over half of patients (n = 4191, 56%) did not wear a HC and 53% (n = 3784/7183) reported minimal hair loss (WHO score 0/1) at the start of their final treatment. Outcomes were drug and dose dependent. Besides the chemotherapy regimen, this study did not identify any patient characteristic or lifestyle factor as a generic determinant influencing SC success. For non-gender specific cancers, gender played no statistically significant role in HC use nor WHO score. Scalp cooling is effective for the majority of patients. The robust model for evaluating the drug and dose-specific determinants of SC efficacy revealed no indications for changes in daily practice, suggesting factors currently being overlooked. As no correlation was identified between the determinants explaining HC use and WHO score outcomes, new methods for evaluation are warranted.

Chemotherapy-Induced Alopecia by Docetaxel: Prevalence, Treatment and Prevention.

Docetaxel is a commonly used taxane chemotherapeutic agent in the treatment of a variety of cancers, including breast cancer, ovarian cancer, prostate cancer, non-small cell lung cancer, gastric cancer, and head and neck cancer. Docetaxel exerts its anti-cancer effects through inhibition of the cell cycle and induction of proapoptotic activity. However, docetaxel also impacts rapidly proliferating normal cells in the scalp hair follicles (HFs), rendering the HFs vulnerable to docetaxel-induced cell death and leading to chemotherapy-induced alopecia (CIA). In severe cases, docetaxel causes persistent or permanent CIA (pCIA) when hair does not grow back completely six months after chemotherapy cessation. Hair loss has severe negative impacts on patients' quality of life and may even compromise their compliance with treatment. This review discusses the notable prevalence of docetaxel-induced CIA and pCIA, as well as their prevention and management. At this moment, scalp cooling is the standard of care to prevent CIA. Treatment options to promote hair regrowth include but are not limited to minoxidil, photobiomodulation (PBMT), and platelet-rich plasma (PRP). In addition, a handful of current clinical trials are exploring additional agents to treat or prevent CIA. Research models of CIA, particularly ex vivo human scalp HF organ culture and in vivo mouse models with human scalp xenografts, will help expedite the translation of bench findings of CIA prevention and/or amelioration to the clinic.

Awareness of the Impacts of Chemotherapy Induced Alopecia among Individuals with Cancer at the Tertiary Hospitals of the Federal Capital Territory, Abuja

Hair is an important aspect of human identity. Chemotherapy induced alopecia (CIA) is a common side effect of the chemotherapy treatment given to cancer patients. The purpose of this study was to determine the awareness of the impacts of chemotherapy induced alopecia among patients with cancer in the tertiary hospitals of the Federal Capital Territory. A cross-sectional research design was adopted for the study. A total of 394 cancer patients with chemotherapy induced alopecia were interviewed for the study. The instrument used for data collection was a researcher developed questionnaire. Data collected were summarized using frequencies, percentages, bar and pie charts. Results showed that 109 of the respondents were males (27.7%) while 285 (72.3%) were females, 215 (54.6%) were Christians, 139 (35.3%) were Muslims, and 26 (6.6%) and 14 (3.9%) were traditionalists and atheists respectively. Over 75% of the respondents reported that they were aware of the various side effects of chemotherapy including alopecia, and about 43% reported chemotherapy induced alopecia as their most devastating side effect of chemotherapy. The results on the impact of CIA also revealed that CIA affected the accomplishment of daily tasks in about 62.4% of the respondents; it also limited about 62.9% of the respondents from going out because of shame. It made about 82% of the respondents appear ugly, and made about 56.6% of the patients always ashamed of themselves. It made about 79.7% of the respondents unable to go out without covering their hair, and about 59.6% of the respondents had difficulty getting enough wigs that fit. The researchers concluded that a greater percentage of the respondents are aware of CIA and that CIA had a great impact on the participants. The researchers therefore recommend that more time should be devoted to creating awareness on the impacts of CIA during clinics.

Therapeutic Effect of Superficial Scalp Hypothermia on Chemotherapy-Induced Alopecia in Breast Cancer Survivors.

Alopecia is a common adverse effect of neoadjuvant or adjuvant chemotherapy in patients with early breast cancer. While hair typically regrows over time, more than 40% of patients continue to suffer from permanent partial alopecia, significantly affecting body image, psychological well-being, and quality of life. This concern is a recognized reason why some breast cancer patients decline life-saving chemotherapy. It is critical for healthcare professionals to consider the impact of this distressing side effect and adopt supportive measures to mitigate it. Among the various strategies investigated to reduce chemotherapy-induced alopecia (CIA), scalp cooling has emerged as the most effective. This article reviews the pathophysiology of CIA and examines the efficacy of different scalp cooling methods. Scalp cooling has been shown to reduce the incidence of CIA, defined as less than 50% hair loss, by 50% in patients receiving chemotherapy. It is associated with high patient satisfaction and does not significantly increase the risk of scalp metastasis or compromise overall survival. Promising new scalp cooling technologies, such as cryogenic nitrogen oxide cryotherapy, offer the potential to achieve and maintain lower scalp temperatures, potentially enhancing therapeutic effects. Further investigation into these approaches is warranted. Research on CIA is hindered by significant heterogeneity and the lack of standardised methods for assessing hair loss. To advance the field, further interdisciplinary research is crucial to develop preclinical models of CIA, establish a uniform, internationally accepted and standardised classification system, and establish an objective, personalised prognosis monitoring system.

Scalp Cooling in Preventing Persistent Chemotherapy-Induced Alopecia: A Randomized Controlled Trial.

Current studies of the efficacy of scalp cooling are limited by short-term duration. Therefore, we conducted a randomized controlled trial to evaluate the efficacy of scalp cooling in reducing persistent chemotherapy-induced alopecia (PCIA) 6 months after chemotherapy. We conducted an open-label randomized controlled trial comparing scalp cooling versus control in newly diagnosed patients with breast cancer stages I-III scheduled to receive neoadjuvant or adjuvant chemotherapy with curative intent between December 2020 and August 2021. Patients were randomly assigned (2:1 ratio) to scalp cooling or usual clinical practice. The primary outcome was PCIA 6 months after chemotherapy. Hair thickness and density were measured using Folliscope 5.0. CIA-related distress was assessed using the CIA distress scale (CADS), with a higher score reflecting higher stress. The proportion of patients with PCIA at 6 months was 13.5% (12/89) in the scalp-cooling group and 52.0% (26/50) in the control group. The average difference in the change in hair thickness from baseline between the scalp-cooling and control groups was 9.0 μm in favor of the intervention group. The average difference in the change in hair density between intervention and control at the end of the study was -3.3 hairs/cm2. At 6 months after chemotherapy, the average difference in the change in CADS score between the intervention and control groups was -3.2 points, reflecting reduced CIA-related stress in the intervention group. Scalp cooling reduced the incidence of PCIA, primarily by increasing hair thickness compared with control. Scalp cooling is helpful in promoting qualitative hair regrowth. Yet, further research is necessary to observe longer-term benefits of scalp cooling.

Actualización de la tricodinia, un reto para los dermatólogos

Trichodynia is the sensation of pain in the scalp, which, in most cases, is associated with certain types of alopecia. Despite being a term coined by Rebora back in 1996 to described patients with diffuse alopecia consistent with telogen effluvium, this symptom has currently been reported in other entities. Androgenic alopecia, scarring alopecia, alopecia areata, trichotillomania, and chemotherapy-induced alopecia are common causes of trichodynia. Similarly, its association with psychiatric comorbidities, including depression, anxiety, obsessive-compulsive disorder and somatoform disorders has been reported with a higher prevalence among women. Although its pathogenesis is still to be elucidate, some factors involved are substanceP, psychiatric comorbidities and perifollicular inflammation. Clinically it exhibits pain or discomfort of the scalp, almost always in association with hair los. The sensation of pain can occur throughout the scalp or locally in some specific areas. Diagnosis is clinical and one of exclusion. Regarding treatment, there are no specific therapies for trichodynia. However, the use of botulinum toxinA, antidepressants, neuromodulators, propranolol, topical corticosteroids, oral corticosteroids and topical cannabinoids are therapeutic alternatives that should be taken into consideration. Since treatment of trichodynia is still therapeutically challenging for dermatologists more prospective studies are needed to evaluate new therapies.

50524 Facebook groups provide support and product recommendations for patients using scalp cooling to prevent chemotherapy-induced alopecia: A survey study

50524 Facebook groups provide support and product recommendations for patients using scalp cooling to prevent chemotherapy-induced alopecia: A survey study

51895 Interim Analysis of Platelet-Rich Plasma (PRP) Treatment for Endocrine Therapy-Induced Alopecia (EIA) and Permanent Chemotherapy-Induced Alopecia (pCIA) in Breast Cancer Patients: A Randomized Controlled Trial

51895 Interim Analysis of Platelet-Rich Plasma (PRP) Treatment for Endocrine Therapy-Induced Alopecia (EIA) and Permanent Chemotherapy-Induced Alopecia (pCIA) in Breast Cancer Patients: A Randomized Controlled Trial

Novel genetic structures associated with adverse response to chemotherapy in breast cancer.

Introduction: The role of genetic variants in response to chemotherapy has been investigated in several studies. This study aimed to investigate genetic variants associated with response to chemotherapy in breast cancer (BC) patients. Methods: Significant variants (p < 5 × 10-8) associated with response to chemotherapy were obtained from GWA studies. Candidate variants were identified by haplotype analysis (r2 ≥ 0.9, D'≥0.9) using 1000Genome LD data. To determine the effects of the variants on gene expression, expression quantitative trait loci (eQTL) were evaluated. To compare the expression of the identified genes in tumor samples, expression levels were compared between TCGA tumor types and adjacent normal tissues. Results: Six rs3820706, rs147451859, rs4784750, rs17587029, rs16830728, and rs16972207 variants were significantly associated with response to chemotherapy in BC patients (p < 5 × 10-8). Seven novel haplotypic structures were identified to be associated with adverse response to chemotherapy in BC patients. These haplotypes formed two genetic structures associated with neutropenia, leukopenia, chemotherapy-induced cytotoxicity (GAG-TTAT), and chemotherapy-induced alopecia (CC-CAACTCCCGTTGCGG). These variants are located on PPCDC, NLRC5, STAM2, and TNFSF13B genes, and the expression of these genes significantly changed in BC tissues than normal tissues (P ≤ 0.05), also showing gene-gene correlation (P ≤ 0.05). Conclusions: These genetic variants and their associated novel haplotypic structures can predict adverse response to chemotherapy in BC patients and could potentially form BC-associated genetic panel for adverse response to chemotherapy.

The Effect of Scalp Cooling in Ameliorating Chemotherapy-Induced Alopecia in Children With Acute Lymphoblastic Leukemia: A Prospective Nonrandomized Trial

The Effect of Scalp Cooling in Ameliorating Chemotherapy-Induced Alopecia in Children With Acute Lymphoblastic Leukemia: A Prospective Nonrandomized Trial

ALL-661 The Effect of Scalp Cooling in Ameliorating Chemotherapy-Induced Alopecia in Children With Acute Lymphoblastic Leukemia: A Prospective Nonrandomized Trial

ALL-661 The Effect of Scalp Cooling in Ameliorating Chemotherapy-Induced Alopecia in Children With Acute Lymphoblastic Leukemia: A Prospective Nonrandomized Trial

Optimization and Transfollicular Delivery of Finasteride Loaded PLGA Nanoparticles Laden Carbopol Gel for Treatment of Hair Growth Stimulation

Background: One of the frequent side effects of cancer treatment is chemotherapyinduced alopecia (CIA). The psychological discomfort of hair loss may cause patients to stop receiving chemotherapy, lowering the therapy's effectiveness. Finasteride (FNS), a JAK inhibitor, has shown tremendous promise in therapeutic uses for treating baldness. Still, systemic side effects constrained its broad use in alopecia from oral treatment and a low absorption rate at the target site— PLGA-loaded nanoparticles (NPs) for topical delivery of FNS—to overcome these issues. Methods: The nano-precipitation process was used to make FNS-NPs. The independent variables (stabiliser and polymer) were PLGA (X1), P407 (X2), and sonication time (X3). Based on the point prediction method obtainable by the Box Behnken design software, the best FNS-NPs composition was selected. Entrapment efficiency, particle size, zeta potential, and polydispersity index were used to characterize the nanoparticles. Using Carbopol as a polymer, the ideal FNS-NPs composition was further transformed into a gel formulation. The prepared topical gel formulation (FNS-NPs gel) included gel characterization, Dynamic Light Scattering (DLS), Scanning Electron Microscopy (SEM), Powder X-ray Diffraction (PXRD), Differential Scanning Calorimetry (DSC), Fourier Transform Infrared Spectroscopy (FTIR), invitro and in vivo studies. Results: Optimized FNS-NPs (F13) had particle sizes of 175.26±3.85 nm, 0.241±0.11 PDI, 71.04±1.35 % EE, and -33.27±0.39 surface charges. There is no interaction between the drug and the excipients, according to FTIR studies. The FNS were visible in the X-ray diffractogram enclosed in a polymer matrix. The developed FNS-NPs gel formulation shows ideal drug content, viscosity, pH, and spreadability. According to the release and permeation investigation findings, FNS released slowly (68.73±0.94%) but significantly permeated the membrane more than before. In a dose- and time-dependent manner, the produced nanoparticles considerably (p≤0.05) increased FNS delivery compared to the FNS solution. The FNS-NPs gel therapy significantly increases the quantity and size of hair follicles dose-dependently. The effectiveness of the 1% FNSNPs gel and the 2% minoxidil solution were comparable. After 72 hours, the FNS-NPs gel showed no signs of skin irritation. The outcomes, therefore, showed that the trans follicular delivery mechanism of the FNS-NPs gel might stimulate hair growth. Conclusion: These findings imply that the innovative formulation that has been developed has several beneficial properties that make it suitable for FNS dermal delivery in the treatment of alopecia areata

Expanding the Availability of Scalp Cooling to All Patients at Risk of Chemotherapy-Induced Alopecia.

Alopecia is an undesirable side effect of cancer chemotherapy. The mitigation of alopecia is a desirable adjunct treatment for patients with cancer. FDA-cleared scalp cooling (SC) devices have been successfully used to prevent or reduce chemotherapy-induced alopecia (CIA). This paper provides an understanding of the implementation and value of the new Insurance-Based Billing Model used in the USA for SC and its benefits compared with the original self-pay model. This improved compensation change will result in all patients in need, including underserved and disadvantaged populations, receiving equitable healthcare by allowing access to this valuable supportive care technology.

BI39 Oncological therapies and hair disorders: a narrative approach on permanent chemotherapy-induced alopecia. A literature review of cancer-related therapies and their associated hair and scalp disorders

BI39 Oncological therapies and hair disorders: a narrative approach on permanent chemotherapy-induced alopecia. A literature review of cancer-related therapies and their associated hair and scalp disorders

Patient and nursing staff perspectives on automated scalp cooling (ASC) for chemotherapy-induced alopecia in breast cancer.

Automated scalp cooling (ASC) is available to patients undergoing chemotherapy for breast cancer to decrease chemotherapy-induced alopecia. This study sought to elucidate patient and chemotherapy nursing perspectives on the ASC experience. This is a survey-based study of chemotherapy nursing staff and patients with breast cancer regarding perceived efficacy, side effects, administration, support, and overall opinions of ASC. Chemotherapy nurses across a large, multi-regional tertiary healthcare system completed a one-time survey regarding their experiences in administering ASC. Breast cancer patients who utilized ASC were surveyed along with a control group who underwent alopecia-inducing chemotherapy without ASC use for comparison. The majority of nursing responses reported inadequate technical support, an increased burden of administering ASC compared to other clinical duties, and that they would not recommend ASC to a family member or friend. Patients who underwent ASC reported significantly less hair loss and were significantly less likely to shave their heads or wear a wig, but this did not translate into significant differences in body image or psychosocial wellbeing responses. Time investment was the most significant burden related to ASC. Patients using ASC reported significantly less hair loss compared to those not using ASC during alopecia-inducing breast cancer chemotherapy, but this did not translate to improved body image. The majority of chemotherapy nurses reported they lacked adequate support in administering ASC and would not recommend it. Enhanced nursing support may provide a means for improving the ASC experience for both nursing staff and patients.

Discovery of petroleum ether extract of eclipta targeting p53/Fas pathway for the treatment of chemotherapy-induced alopecia: Network pharmacology and experimental validation

Ethnopharmacological relevanceEcliptea herba, a traditional Chinese herbal medicine for hair loss, was first recorded in the Tang Dynasty's ‘Qian Jin Yue Ling’, of which the active ingredients and mechanisms of action in the treatment of chemotherapy-induced hair loss remain poorly investigated. Aim of the studyTo investigate the effects of the petroleum ether extract of Eclipta (PEE) on alopecia and follicle damage and elucidate its potential therapeutic mechanisms using the integration of network pharmacology, bioinformatics, and experimental validation. Materials and methodsUPLC-MS was used to analyse the chemical composition of PEE. A network pharmacology approach was employed to establish the ‘components-targets-pathways’ network of PEE to explore potential therapeutic pathways and targets. Molecular docking was used for validation, and the mechanism of PEE in treating chemotherapy-induced alopecia (CIA) was elucidated using in vitro and in vivo on CIA models. ResultsUPLC-MS analysis of PEE revealed 185 components, while network pharmacology and molecular docking analyses revealed potential active compounds and their target molecules, suggesting the involvement of core genes, such as TP53, ESR1, AKT1, IL6, TNF, and EGFR. The key components included wedelolactone, dimethyl-wedelolactone, luteoloside, linarin, and hispidulin. In vivo, PEE promoted hair growth, restored the number of hair follicles, and reduced follicle apoptosis. Conversely, in vitro, PEE enhanced cell viability, reduced apoptosis, and protected HaCaT cells from damage induced by 4-hydroperoxycyclophosphamide (4-HC). ConclusionsPEE alleviated hair follicle damage in CIA mice by inhibiting the P53/Fas pathway, which may be associated with inhibiting hair follicle cell apoptosis. This study provides a novel therapeutic strategy for treating cyclophosphamide-induced hair loss.

Improving chemotherapy-induced alopecia for women receiving anthracycline plus taxane chemotherapy using the Paxman scalp cooling system at lower temperatures.

12143 Background: Chemotherapy-induced alopecia (CIA) not only impacts physical appearance but may also be detrimental to patient’s psychological well-being. To address CIA, patients often use scalp cooling devices such as the FDA-approved Paxman Scalp Cooling System (PSCS), currently approved at -5°C. This study explores the potential benefits of lower temperatures, -7.5°C and -10°C, to improve the efficacy of PSCS in minimizing CIA. Methods: This prospective study analyzed data from 33 women with stage I-III breast cancer receiving anthracycline and taxane chemo at MSKCC from 12/2019–10/2022. Photography, trichoscopy, and toxicity checks were conducted at baseline, weeks 4, 8 (primary endpoint), end of treatment (EOT), and 24 weeks post-chemotherapy. 23 patients reached week 8, while 10 withdrew prior due to lack of efficacy (5/10), change in treatment (3/10), or anxiety (2/10). Successful hair preservation (HP) was defined as CTCAE v4 grade 0 or 1 alopecia. Results: At baseline, all patients had grade 0 alopecia. At week 4, 81% achieved successful HP (17/21), and at week 8, over half maintained it (53%; 9/17). The majority had HP at EOT (69%; 11/16). At 24 weeks post-chemotherapy, all patients demonstrated continued HP (100%; 11/11) and all evaluated patients at 18 months post-treatment had grade 0 alopecia (100%,4/4). Among women with baseline photographs and trichoscopy (n=25), median average hair count at baseline was 154.0 per cm² and width 70.2 per cm². By week 4 (n=21), the median average hair count decreased by 20.0%, and width decreased by 8.0% compared to baseline. By week 8 (n=17), average count improved by 15% compared to week 4 (-3% from baseline) and average width decreased by 6% (-7.5% baseline). At EOT hair count decreased 37.8% and width decreased by 11.6% compared to baseline (n=16). At 24 weeks post-EOT there was a 13% increase in median average hair count with no measurable change in width compared to baseline (n=12). No patients (0%; 0/33) reported dose-limiting toxicities (DLTs) at -7.5°C (n=7) or -10°C (n=26). Conclusions: Patients successfully tolerated scalp cooling at lower temperatures, with no reported dose-limiting toxicities and successful HP. This study indicates higher HP rate at EOT (69%; 11/16) compared to studies using PSCS at -5°C. Post-EOT data shows successful hair regrowth with a higher average hair count than pre-treatment. A larger sample size is needed to assess the additional benefit of lower temperatures on HP and regrowth. Clinical trial information: NCT.[Table: see text]