Scalp Cooling in Preventing Persistent Chemotherapy-Induced Alopecia: A Randomized Controlled Trial

Author(s): Danbee Kang, PhD^1,2; Juhee Cho, PhD^1,2; Di Zhao, PhD^3,4; Jeonghyun Kim, MS⁵; Nayeon Kim, MSN^1,5; Hoyoung Kim, MPH⁵; Sooyeon Kim, BS^1,2; Ji-Yeon Kim, MD, PhD⁶; Yeon Hee Park, MD, PhD⁶; Young Hyuck Im, MD, PhD⁶; Eliseo Guallar, MD, DrPH^1,2,3,4; Jin Seok Ahn, MD, PhD⁶

Source: https://doi.org/10.1200/JCO.23.02374

Dr. Anjan Patel's Thoughts

I guess scalp cooling does have some objective evidence that it works. Still the expense and time constraints will need to be considered.

PURPOSE

Current studies of the efficacy of scalp cooling are limited by short-term duration. Therefore, we conducted a randomized controlled trial to evaluate the efficacy of scalp cooling in reducing persistent chemotherapy-induced alopecia (PCIA) 6 months after chemotherapy.

METHODS

We conducted an open-label randomized controlled trial comparing scalp cooling versus control in newly diagnosed patients with breast cancer stages I-III scheduled to receive neoadjuvant or adjuvant chemotherapy with curative intent between December 2020 and August 2021. Patients were randomly assigned (2:1 ratio) to scalp cooling or usual clinical practice. The primary outcome was PCIA 6 months after chemotherapy. Hair thickness and density were measured using Folliscope 5.0. CIA-related distress was assessed using the CIA distress scale (CADS), with a higher score reflecting higher stress.

RESULTS

The proportion of patients with PCIA at 6 months was 13.5% (12/89) in the scalp-cooling group and 52.0% (26/50) in the control group. The average difference in the change in hair thickness from baseline between the scalp-cooling and control groups was 9.0 μm in favor of the intervention group. The average difference in the change in hair density between intervention and control at the end of the study was –3.3 hairs/cm2. At 6 months after chemotherapy, the average difference in the change in CADS score between the intervention and control groups was –3.2 points, reflecting reduced CIA-related stress in the intervention group.

CONCLUSION

Scalp cooling reduced the incidence of PCIA, primarily by increasing hair thickness compared with control. Scalp cooling is helpful in promoting qualitative hair regrowth. Yet, further research is necessary to observe longer-term benefits of scalp cooling.

Author Affiliations

¹Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea; ²Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; ³Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ⁴Department of Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD; ⁵Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; ⁶Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

Prescribing Changes After Accelerated vs Regular Approval of Oncology Therapies

This study analyzed prescribing patterns for oncology drugs granted FDA Accelerated Approval (AA) versus those later converted to Regular Approval (RA) using data from over 63,000 patients with advanced solid tumors. Prescribing of AA drugs increased sharply—by an average of 23 percentage points—immediately after AA, while conversion to RA led to only a minimal further increase. Off-label use of AA drugs, either in earlier lines of therapy or in biomarker-negative patients, was rare. The findings suggest that oncologists rapidly adopt AA drugs into practice, often without waiting for confirmatory evidence required for RA. In summary, AA status drives substantial and immediate uptake of oncology drugs, highlighting the importance of timely confirmatory trials to ensure clinical benefit.

Mapping the rapid growth of multi-omics in tumor immunotherapy: Bibliometric evidence of technology convergence and paradigm shifts

The article demonstrates that multi-omics research in tumor immunotherapy has grown rapidly since 2019, with China leading in publication volume but showing limited international collaboration. Early research focused on immune checkpoint blockade, while recent trends emphasize machine learning, multi-omics integration, and lncRNA, reflecting a shift toward predictive modeling and biomarker discovery. Multi-omics approaches have enabled the development of immune infiltration-based prognostic models and identified metabolic and spatial biomarkers, such as oxidative phosphorylation in melanoma and ENPP1 in Ewing sarcoma, which may guide therapeutic strategies. Overall, the study provides a systematic framework for tracking technological convergence and emerging frontiers, highlighting the need for longitudinal omics monitoring, AI-driven integration, and enhanced international collaboration to optimize precision-driven tumor immunotherapy.

Nonoperative Management of Mismatch Repair—Deficient Tumors

Two cohorts, one for patients with colon cancer and the second for all other patients. Of the 103 patients who completed treatment across both cohorts, 84 had a clinical complete response and 82 did not undergo surgery. Among the 117 total patients, recurrence-free survival at two years was 92%. Only 20-months follow up for now. It will be interesting to see how this goes with future updates but seems promising.

Abelacimab versus Rivaroxaban in Patients with Atrial Fibrillation

This new subcutaneous anticoagulant, abelacimab, binds to the inactive form of FXI and blocks its activation by FXII. This drug seems significantly safer than DOAC’s in terms of bleeding risk. So much so that the study was stopped early due to a greater-than-expected reduction in bleeding events in the study arm. I hope this drug is also going to be studied for the treatment of VTE.

Corticosteroids for Immune-Related Adverse Events and Checkpoint Inhibitor Efficacy: Analysis of Six Clinical Trials

Pooled data of nearly 2000 patients across six trials in melanoma using IO therapy. It seems clear that high dose corticosteroid use was associated with worse outcomes, especially with high peak doses. What may be worth considering is if non-steroid based immunosuppression can be used as an adjunct to blunt this concerning effect.