Persistent Major Alopecia Following Adjuvant Docetaxel for Breast Cancer: Incidence, Characteristics, and Prevention with Scalp Cooling

The study investigated the occurrence of persistent alopecia (PA) in breast cancer patients treated with adjuvant docetaxel and the efficacy of scalp cooling in preventing this condition. It was found that patients receiving docetaxel at cumulative doses (CD) ≥ 400 mg/m² had a high prevalence of PA, with grade 2 PA affecting about 10% of 358 patients, necessitating the use of a wig. However, in a prevention trial, none of the 116 patients who received scalp cooling alongside docetaxel at CD≥400 mg/m² developed grade 2 PA after a median follow-up of 96 months, and scalp cooling was well tolerated without any scalp relapses among those who experienced disease relapse. The study concluded that scalp cooling is highly effective in preventing PA caused by docetaxel, with only a 0.8% incidence of grade 1 PA and no grade 2 PA observed in 120 evaluable patients after 8 years, and no scalp metastases were detected.