编者按：短暂脱发是仅次于呕吐的化疗药物常见不良反应，某些化疗药物可能引起持续脱发，例如多西他赛辅助治疗乳腺癌后可能引起持续大量脱发。
2018年6月19日，施普林格·自然旗下《乳腺癌研究与治疗》在线发表西班牙马德里大学、癌症网络生物医学研究中心、格雷戈里奥马拉尼翁综合医院、圣卡洛斯医院、科米利亚斯主教大学、巴伦西亚大学医院的研究报告，调查了多西他赛辅助治疗乳腺癌后持续大量脱发的发生率、特征、头皮冷却预防作用。
该研究首先查找在单个医院初次诊断为乳腺癌接受辅助化疗±内分泌治疗（对照组仅接受内分泌治疗）持续脱发并随访1.5～5年的患者，随后在其他两个医院进行发生率验证研究。最后，对接受多西他赛辅助治疗的患者通过弹性凝胶低温帽进行头皮冷却预防预防研究。
结果，单个医院发生率研究患者492例，所有化疗方案和芳香酶抑制剂的患者都记录到轻度（1级）持续脱发。患者接受多西他赛治疗累积剂量≥400mmg/m²的持续脱发发生率显著较高（1级33～52%、2级5～12%）。其他两个医院确认多西他赛累积剂量≥400mmg/m²的2级持续脱发发生率较高。
三个医院总计358例患者多西他赛累积剂量≥400mmg/m²的2级持续脱发发生率为10.06%（95%置信区间：7.36～13.61），但是多西他赛累积剂量较低、其他化疗方案、单用内分泌治疗的患者无此结果。
预防研究接受多西他赛辅助治疗≥400mmg/m²和头皮冷却预防中位随访96个月的116例患者未见2级持续脱发。头皮冷却预防的耐受性好，其中疾病复发患者30例（22%）未见头皮复发。
因此，多西他赛辅助治疗累积剂量≥400mmg/m²与2级持续脱发发生率显著相关，引起大约10%的患者戴假发。头皮冷却可以完全预防2级持续脱发。
Breast Cancer Res Treat. 2018 Jun 19.
Persistent major alopecia following adjuvant docetaxel for breast cancer: incidence, characteristics, and prevention with scalp cooling.
M. Martín, J. C. de la Torre-Montero, S. López-Tarruella, K. Pinilla, A. Casado, S. Fernandez, Y. Jerez, J. Puente, I. Palomero, R. González del Val, M. del Monte-Millan, T. Massarrah, C. Vila, B. García-Paredes, J. A. García-Sáenz, A. Lluch.
Hospital General Universitario Gregorio Maranón, Instituto de Investigación Sanitaria Gregorio Maranón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), CIBERONC, Madrid, Spain; Universidad Pontificia Comillas, Madrid, Spain; Hospital Clínico Universitario, CIBERONC, Valencia, Spain.
BACKGROUND: Persistent alopecia (PA) after docetaxel has been recently described. The aim of our study is to establish the incidence and characteristics of PA following adjuvant docetaxel for breast cancer (BC) and to test the ability of scalp cooling in prevention.
PATIENTS AND METHODS: BC patients receiving adjuvant chemotherapy followed or not by endocrine therapy (and a control group receiving only endocrine therapy) were interviewed in a single institution at 1.5 to 5 years following primary diagnosis searching for PA. A confirmatory prevalence study was later performed in other two institutions. Finally, a prevention study using prophylactic scalp cooling (PSC) with ELASTO-GEL hypothermia caps in patients receiving adjuvant docetaxel was performed.
RESULTS: In the initial prevalence study (492 patients), minor forms of PA (grade 1) were recorded with all chemotherapy regimens and aromatase inhibitors. Patients receiving docetaxel regimens at cumulative dose (CD)≥400 mmg/m²presented a significantly higher prevalence of grades 1 PA (33-52%) and 2 PA (5-12%). Prevalence of grade 2 PA with docetaxel CD≥400 mmg/m² was confirmed in two other institutions. Overall, grade 2 PA was seen in 10.06% (95% CI 7.36-13.61) of 358 patients with docetaxel regimens reaching CD≥400 mmg/m², but not in patients with lower docetaxel CD, other chemotherapy regimens, or endocrine therapy alone. In prevention trial, no grade 2 PA occurred among 116 patients receiving adjuvant docetaxel (≥400 mmg/m2) and PSC followed-up after a 96 months median time. PSC was well tolerated. No scalp relapses were seen among 30 patients (22% of all inclusions) having disease relapse.
CONCLUSION: Adjuvant treatment with docetaxel (CD≥400 mmg/m²) is associated with a significant rate of grade 2 PA, leading to wearing a wig, in around 10% of patients. This toxicity was completely prevented with scalp cooling.
CLINICAL TRIAL REFERENCE: NCT00515762.
KEYWORDS: Alopecia; Breast cancer; Docetaxel; Scalp cooling
DOI: 10.1007/s10549-018-4855-2
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