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Cutaneous toxicities from chemotherapy can be serious enough to stop cancer treatment, making it important for oncologists to consult dermatologists early on, said the senior investigator of a systematic review of therapies to prevent taxane-induced cutaneous adverse effects.

Some patients are “three-quarters of the way through their treatment, they’ve lost all their hair and their skin is a wreck,” before they see a dermatologist, said Adam Friedman, MD, from the George Washington University School of Medicine & Health Sciences in Washington, DC.

“If I could get them before they reach such a state, that would be ideal,” he told Medscape Medical News.

This is an area of “great need,” and dermatologists can “really improve quality of life for so many patients,” said Friedman, who presented the research at the American Academy of Dermatology 2019 Annual Meeting in Washington, DC.

“Every chemo center has courses and classes, from nutrition to medications. Derm should be part this,” he said. “There is a lot of emerging evidence showing that dermatologists can prevent these toxicities by starting treatments early on.”

Taxane-Induced Alopecia, Skin and Nail Changes

Docetaxel and paclitaxel are among the most common therapeutic agents implicated in chemotherapy-induced alopecia and nail toxicity, occurring in a majority — up to 89%, — of patients receiving taxane-based chemo,” Friedman reported.

“These adnexal changes are associated with cosmetic concerns, psychosocial distress, and overall morbidity,” he said.

“We see a lot of these dermatologic adverse effects at our clinic,” he told Medscape Medical News, which is why “we decided to assess the actual evidence for the prevention and management of these toxicities, especially those specific to taxanes.”

He and his colleagues identified studies published from January 1980 to August 2018 that addressed preventive interventions for alopecia associated with the use of taxanes and that focused on skin and nail changes in PubMed and Scopus databases.

Of the 22 studies that looked at interventions for chemo-induced hair loss, 95% supported the use of either cold caps or a scalp-cooling system, although the effectiveness of these two methods was related to the chemotherapy regimen.

Scalp cooling was generally considered safe in all relevant studies, but there was one report of scalp skin metastasis, Friedman reported.

Of the 12 studies on interventions for skin and nail changes, 67% supported the use of frozen gloves and frozen socks. Most of the studies considered these methods to be safe, but discomfort with the gloves and socks was a frequent complaint, and one patient developed frostbite.

There was not as much evidence for hand and foot cooling as there was for scalp cooling. “In fact, one take away from our study is that it is a call to action for more research in this area,” said Friedman.

“As with all new and evolving therapies, there never seems to be enough evidence,” said Robert Brodell, MD, from the University of Mississippi Medical Center in Jackson.

Still, he said, “the use of hypothermia appears to be very safe, and my read of the evidence is that it is most probably effective at preventing taxane-induced alopecia and nail toxicity. It certainly is an advantage that patients may be more inclined to continue their therapy to completion if they are not losing their hair and nails.”

Not every dermatologist is up to date on these preventive therapies, but “dermatologists at most major medical centers are likely to be able to discuss this option with patients during the planning phase of their chemotherapy,” he added.

Supportive oncodermatology is currently considered a fledgling field, but it needs to become part of the core curriculum for dermatologists.

Friedman would like to see more oncologists refer their patients to dermatologists so that the effects of taxanes can be properly managed.

“There is so much that dermatologists can do to lessen or prevent these toxicities. Supportive oncodermatology is currently considered a fledgling field, but it needs to become part of the core curriculum for dermatologists,” he said.

“There are only seven centers in the United States, besides George Washington, that have this specialized focus. People are beginning to recognize its importance, but change is always slow; it takes time for everyone to get on board.”

“We know that a percentage of women say they do not want to get treatment for breast cancer because of hair loss. But dermatologists can manage these symptoms and enable completion of therapy. My hope from this research is that we will get more dermatologists and oncologists working together,” said Friedman.

Friedman and Brodell have disclosed no relevant financial relationships.

American Academy of Dermatology (AAD) 2019 Annual Meeting. Presented March 2, 2019.

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