Dr. Julie Rani Nangia

While chemotherapy causes hair loss in many patients with cancer, particularly in the treatment of breast cancer, the type and sequence of chemotherapies used can have an impact on the amount of hair lost when scalp cooling systems are also used for hair preservation, said Dr. Julie Rani Nangia.

Nangia explained that not only does the fit of a cold cap help prevent hair loss during treatment, but that the order in which certain chemotherapies are given also matter, as the results of two large studies examining the use of cold caps and chemotherapy have found.

: What percentage of hair do people keep when they use the system?

: That number really varies. In our study, with all types of breast cancer, the hair retention rate was 50%. And what we saw is that it really depends on two big factors. One is the fit of the cap, and two is the type of chemotherapy.

There are certain chemotherapies, like there's a chemo called Paclitaxel, that's usually given on a weekly basis. With that chemotherapy in both of the big US clinical trials, the hair retention rate was 100%. And we define hair retention by losing less than 50% of your hair and not needing a wig. So, people did have hair thinning but they didn't feel like they needed a wig and when they went out in public, they felt normal.

Now there is a chemotherapy called anthracycline, so these are drugs like Adriamycin, and in our study the hair retention rate was around 20% with that drug, but there were a couple studies that came out after, and this is why I say the order (of chemotherapy) matters. Showing that if you sequence to a drug like Paclitaxel, prior to the anthracycline, that the hair retention rate was closer to 40%. The thought among the people in the field, including me, is what happens is when you wear that cap for 12 times, like you would with Paclitaxel, and it's more effective with that chemo, that you get really good at using it. You get better at fitting it, and there's less gaps, and I really do think that it has to do with the fit.

And so, when I am giving chemotherapy to patients, and I'm a breast cancer specialist, I do use the group of drugs called taxanes, which includes Paclitaxel first, and then I use the drugs of anthracyclines second, and I have noticed significant improvements in hair retention rates. I've had a had a few patients who, even when they lost hair, they kept using it, even though they needed a wig.

Anecdotally, we've seen in our practice that you see hair regrowth faster. And there was a Japanese study that was presented at the San Antonio Breast Cancer Conference last year, which showed that women had their hair growing much faster and much quicker if they use these devices after completion of chemotherapy.

So, if you're sequencing the chemotherapy, so these will be patients that would already be scheduled to get both of those different kinds of chemotherapy…

(In therapy) the order doesn't really matter. But a lot of people are just kind of stuck in their routines and ways, so a lot of practices give the anthracycline first, and there's not really a medical reason to have to use that sequence.

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Dr. Julia Rani Nangia explains how certain chemotherapy types and sequencing have different impacts on hair retention for patients with breast cancer.

Chemotherapy Type and Sequence Can Impact Hair Retention in Breast Cancer

Hair loss is just one of the many unwelcome side effects that patients with cancer may endure as a result of treatment with chemotherapy. But the use of cold caps — also known as scalp cooling – is a safe way to potentially reduce the amount of hair loss in some patients with solid tumors, according to Dr. Julie Rani Nangia of the Baylor College of Medicine.

In a recent interview with CURE, Nangia explained the science behind scalp cooling and went into greater detail about why the process is safe for patients with solid tumors like breast or ovarian cancer but should be avoided by those with blood cancers such as leukemia or lymphoma.

The way cold caps work — I'm going to kind of simplify it an easy way to understand – but there are kind of two main ways that they work. There are two big companies in the US: DigniCap and Paxman, and Paxman is the company that I worked with. But they're very similar and they basically have this mini refrigeration unit that attaches to a cold cap.

And these are different than the caps that you put in the freezer and put on that aren't attached to anything, because it circulates coolant and it keeps the cold temperature at a constant level on the scalp. And this is easier for both providers and patients because when you do scalp cooling, the fit is really important because if you have areas where there's not contact, you lose hair in those areas. So, you can just get a really good fit with a cap at the beginning of treatment and not have to keep putting it on and off. And then you have this constant temperature, you're not going from like really cold and drying out to warmer.

What this cold temperature does is two things: it constricts the blood vessels in the scalp and helps prevent chemotherapy delivery to the hair follicles, and then it also decreases the protein and enzyme activity in the hair follicles so the chemo that is delivered may not work as efficiently in the hair follicles. It's the combination of those two things.

And as far as safety goes, there's actually quite a few very large studies from other countries and US data also shows that these are safe to use. And what these studies have shown is that people who use scalp cooling devices or caps, that there's no difference in survival, so how long they live, and that there's no difference in having cancer recur in the scalp.

This is true for solid tumors. And by solid tumors, I mean cancers like breast cancer, lung cancer, ovarian cancer. But there are some cancers that spread through the bloodstream like leukemias and lymphomas, and in those types of cancers, these devices are not safe because you can protect cancer cells in the scalp and see local recurrences. So, I would not recommend using these for those types of tumors.

But these devices have been very well studied and they're FDA cleared for most solid tumors.

Hair loss is a common side effect in treatment for cancer, but for patients looking to manage it Dr. Julie Rani Nangia breaks down how scalp cooling can slow down hair loss.

Dr. Julie Rani Nangia

Chemotherapy Type and Sequence Can Impact Hair Retention in Breast Cancer

Scalp Cooling: How Does It Work and How Safe Is It?

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