Reduced Post-Infusion Cooling Prevents Paclitaxel-Induced Alopecia

A hair brush with lost hair
A hair brush with lost hair
Researchers sought to investigate if post-infusion cooling time (PICT) could be reduced for patients treated with paclitaxel.

In patients treated weekly with paclitaxel, chemotherapy-induced alopecia (CIA) can be controlled as effectively with a 20-minute post-infusion cooling time (PICT) as with 45- or 90-minute PICT, according to study results published recently in Supportive Care in Cancer.

CIA can be prevented with scalp cooling, researchers reported. Scalp cooling in patients treated with docetaxel had previously been reduced from 90 to 45 and 20 minutes, therefore, researchers sought to investigate if PICT could also be reduced for patients treated with paclitaxel.

To accomplish this, they conducted a multi-center, open-label, prospective, randomized trial ( Identifier: NCT03266185) that included 93 patients recruited from The Haga Hospital, the Hague, the Leiden University Medical Center, Leiden, and the Dutch Cancer Institute, Amsterdam, 2 of whom then decided not to participate. The remaining 91 patients were randomly assigned into 20-minute PICT (n=46; 57±11.1 years of age; 91% women; 63% cancer) and 45-minute PICT (n=45; 58±13.7 years of age; 98% women; 73% cancer), of whom 17 stopped participation due to intolerance, disease progression, or refusal to continue 20-minute PICT (n=38) and 45-minute PICT (n=36). Researchers used prospective data from the Dutch Scalp Cooling Registry for comparison with a 90-minute PICT (n=723; 57±12.1 years of age; 97% women; 82% cancer), no mention whether these were randomly chosen, or demographically matched. The percentage of patients who subsequently decided not to wear a head covering or wig was the primary outcome.

Of the 38 patients in the 20-minute PICT group, hair preservation was accomplished for 82%, and of the 36 patients in the 45-minute PICT, hair preservation was accomplished for 75%, the same success rate for those with the standard 90-minute PICT (85%; P =.29). Secondary outcomes assessing CIA severity with the Dean scale and the NCI CTC toxicity version 4.03 also showed no difference between the 20-minute and 45-minute groups (P =.12 and P =.38, respectively.)

The possibility of nonresponse bias (19 of 93 [20%]) or of selection bias was not discussed, the investigators noted.

Researchers concluded that, “A 20-min PICT is as effective as 45 and 90 min to prevent weekly paclitaxel-induced alopecia and should be the new standard of care.” Scalp cooling with taxane treatment may lower the occurrence of permanent CIA, they wrote. Researchers noted that some patients reject scalp cooling due to additional hospital-time investment, so reducing PICT may prove a significant benefit.


Lugtenberg RT, van den Hurk CJG, Smorenburg CH, et al. Comparable effectiveness of 45- and 20-min post-infusion scalp cooling time in preventing paclitaxel-induced alopecia – a randomized controlled trial. Support Care Cancer. Published online May 2, 2022. doi:10.1007/s00520-022-07090-7