Comparable effectiveness of 45-min and 20-min post-infusion scalp cooling time in preventing paclitaxel-induced alopecia – a randomized controlled trial

Purpose Scalp cooling can prevent chemotherapy-induced alopecia (CIA). Previously, the post-infusion cooling time (PICT) could be successfully reduced in docetaxel-treated patients from 90 to 45 and 20 minutes. Therefore it seems plausible that the PICT can be shortened for paclitaxel-treated patients as well. Methods Patients treated with weekly paclitaxel were included in this multi-center trial and randomly assigned to a PICT of 45 or 20 minutes. The results were compared to a standard PICT of 90 minutes, derived from prospective collected data from the Dutch Scalp Cooling Registry. The primary endpoint was the percentage of patients who decide to not wear a wig or head covering. Secondary endpoints were the degree of CIA assessed with the Dean scale for assessment of hair loss; alopecia graded according to NCI CTC toxicity version 4.03 (CTCAE4.03); tolerance of scalp cooling and perceived distress of CIA. Results 91 patients were enrolled in this study, 74 patients were evaluable for hair loss. Hair preservation was successful in 27 patients (75%) with a PICT of 45 minutes and in 31 patients (82%) with a PICT of 20 minutes. There was no difference in success rate with the standard PICT of 90 minutes (85%, p = 0.29). Similar success rates were seen when using the Dean sale and CTCAE assessment, with no differences between groups (p = 0.12 and p = 0.38). Conclusions A 20 minute PICT is as effective as 45 and 90 minutes to prevent weekly paclitaxel-induced alopecia and should be the new standard of care.