Cryotherapy may curb taxane-induced dermatologic side effects

11/07/2018

By Marilynn Larkin

NEW YORK (Reuters Health) - Cooling the scalp may help prevent taxane-induced alopecia, whereas frozen gloves and socks may prevent nail and cutaneous side effects of the drugs, researchers say.

"I absolutely recommend these cooling modalities," Dr. Adam Friedman of George Washington University School of Medicine and Health Sciences in Washington, DC, told Reuters Health by email.

However, he added, "they only work if used at the initiation of chemotherapy, as they are more preventive then anything else" - and patients often see dermatologists too late, after the side effects have occurred.

"We are changing that paradigm by working closely with the GW Cancer Center, through multidisciplinary clinics and hope to serve as a model for better oncology-dermatology collaboration and holistic management of cancer patients," he said.

Dr. Friedman and colleagues searched the literature from 1980 to August, 2018 for primary clinical studies that detailed preventive interventions for taxane-induced dermatologic adverse events. A total of six randomized clinical trials, four nonrandomized clinical trials, 18 cohort studies, three case-control studies, one cross-sectional study and two case reports were included, involving 5,647 participants.

As reported online October 31 in JAMA Dermatology, 22 studies addressed preventive interventions for taxane-induced alopecia and 12 focused on 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; however, efficacy varied substantially, depending on the chemotherapy regimen. Scalp cooling was generally considered safe in all relevant studies, although there was one report of scalp skin metastasis.

Similarly, use of frozen gloves and frozen socks to prevent nail and cutaneous hand and foot adverse effects was considered safe in seven (88%) of eight studies; however, discomfort was common and one patient got frostbite. Overall, frozen gloves were endorsed by four (67%) of six studies to prevent nail toxic effects and by three (60%) of five studies to prevent cutaneous hand changes.

"With new drugs come new reactions," Dr. Friedman said. "The exponential explosion of new targeted cancer drugs will only increase the frequency of dermatologic complications, all of which have been shown to have a tremendous impact on patient quality of life, sometimes to such an extreme that these life-saving medications are discontinued or reduced, when simple interventions could enable treatment completion."

"While a fledging field, supportive oncodermatology will only continue to expand, and building on our fund of knowledge in this area and dissemination to both dermatologists and oncologists is of the utmost importance to minimize the trauma patients endure due to both their cancer and its treatment," he concluded.

Dr. Rachel Nazarian, a dermatologist at Mount Sinai Hospital in New York City, commented by email, "Many cancer centers have already changed how they treat patients to consider (hair and nails preservation adjuvant therapy) with this hypothermic technique."

"It's typically safe, well tolerated, and does not increase risk for metastasis or non-response to therapy," she told Reuters Health.

Dr. Evan Rieder of NYU Langone Health, also in New York City, agreed. "Cryotherapy seems to be a safe and effective means of preventing much of the devastating hair loss and nail changes that characterize these difficult treatment regimens," he said in an email to Reuters Health.

"Though more evidence is needed, particularly with respect to cooling temperatures, times, and standardized protocols, cryotherapy is a practice-changing treatment for more comfortable and less psychologically distressing chemotherapy experiences," he concluded.

SOURCE: http://bit.ly/2QqsJwO

JAMA Dermatol 2018.

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