Abstract
Background
Nail changes are among the most common dermatological adverse events in paclitaxel-receiving
patients. Although effective, low-temperature prophylactic cryotherapy is discomforting
and a potential cause of side effects, resulting in low patients’ adherence.
Patients and Methods
A phase 2 single-arm study evaluating mild cryotherapy for the reduction of 12-week,
grade 2 nail toxicity was conducted on 67 taxane-naïve breast cancer patients (age
18-74 years) undergoing weekly adjuvant chemotherapy with paclitaxel. Instant-ice
packs were fixed over the fingers and toes for a total of 70 minutes during paclitaxel
infusion at a temperature between -5°C and +5°C. Nail toxicity was evaluated weekly
(CTCAE v. 4.03), including grade 2 (i.e., onycholysis, subungual hematoma, onychomadesis) and grade 1 nail toxicities.
Results
Twelve patients experienced grade 2 nail toxicities (17.9%, 95% confidence interval
[CI] 9.6-29.2%; median time to onset: 56 days): onycholysis was the most frequent
grade 2 toxicity (13.4%), followed by subungual hematoma (9.0%) and onychomadesis
(1.5%). Grade 1 toxicity occurred in 33 patients (63.5%, 95% CI 49.0-76.4%) with nail
discoloration representing by far the most frequent toxicity (59.6%). Seventeen patients
(25.4%) reported no nail toxicity. 62.7% of patients reported no pain and 22.4% suffered
moderate pain. No patient experienced severe pain or others adverse effects.
Conclusions
Instant-ice pack is a feasible prophylactic intervention for nail toxicity, well tolerated
by patients and with limited impact on routine workload. It could be considered for
patients refusing (or interrupting) cryotherapy, and it can be implemented when frozen
gloves management is not feasible.
MicroAbstract
A phase 2, single-arm trial was conducted to evaluate mild-temperature cryotherapy
efficacy in preventing paclitaxel-induced nail toxicity. Instant-ice packs were fixed
over the fingers and toes of 67 breast cancer patients for 70 minutes during paclitaxel
infusion. Twelve patients (18%) reported grade 2 nail toxicity. This is a well-tolerated
prophylactic treatment that can be proposed to patients refusing low-temperature cryotherapy.
Keywords
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References
- Docetaxel and paclitaxel in the treatment of breast cancer: a review of clinical experience.Oncologist. 2004; 9 (Suppl): 24-32https://doi.org/10.1634/theoncologist.9-suppl_2-24
- Managing taxane toxicities.Support Care Cancer. 2003; 11: 144-147https://doi.org/10.1007/s00520-002-0405-9
- Dermatological adverse events with taxane chemotherapy.Eur J Dermatol. 2016; 26: 427-443https://doi.org/10.1684/ejd.2016.2833
- Taxane-induced nail changes: incidence, clinical presentation and outcome.Ann Oncol. 2003; 14: 333-337https://doi.org/10.1093/annonc/mdg050
- The risk of nail changes with taxane chemotherapy: a systematic review of the literature and meta-analysis.Br J Dermatol. 2015; 173: 842-845https://doi.org/10.1111/bjd.13743
- Cryotherapy for docetaxel-induced hand and nail toxicity: randomised control trial.Support Care Cancer. 2014; 22: 1375-1383https://doi.org/10.1007/s00520-013-2095-x
- Evaluation of Prevention Interventions for Taxane-Induced Dermatologic Adverse Events: A Systematic Review.JAMA Dermatol. 2018; 154: 1465-1472https://doi.org/10.1001/jamadermatol.2018.3465
- Prophylactic management for taxane-induced nail toxicity: A systematic review and meta-analysis.Eur J Cancer Care (Engl). 2019; 28: e13118https://doi.org/10.1111/ecc.13118
- Preventing taxane-related peripheral neuropathy, pain and nail toxicity: a prospective self-controlled trial comparing hilotherapy with frozen gloves in early breast cancer.Breast Cancer Res Treat. 2022; (Published online January 4)https://doi.org/10.1007/s10549-021-06477-0
- Taxane-induced nail changes: Predictors and efficacy of the use of frozen gloves and socks in the prevention of nail toxicity.Eur J Oncol Nurs. 2012; 16: 270-275https://doi.org/10.1016/j.ejon.2011.06.007
- Degree of freezing does not affect efficacy of frozen gloves for prevention of docetaxel-induced nail toxicity in breast cancer patients.Support Care Cancer. 2012; 20: 2017-2024https://doi.org/10.1007/s00520-011-1308-4
- Multicenter study of a frozen glove to prevent docetaxel-induced onycholysis and cutaneous toxicity of the hand.J Clin Oncol. 2005; 23: 4424-4429https://doi.org/10.1200/JCO.2005.15.651
- Cryotherapy for the prevention of weekly paclitaxel-induced peripheral adverse events in breast cancer patients.Support Care Cancer. 2020; 28: 5005-5011https://doi.org/10.1007/s00520-020-05345-9
- Frostbite as a complication of frozen gloves in the prevention of docetaxel-induced onycholysis.Eur J Dermatol. 2011; 21: 628-629https://doi.org/10.1684/ejd.2011.1390
- Prospective Study of Ice Gel Pack as Less Expensive Alternative for Prevention of Skin and Nail Toxicity in Patients with Breast Cancer Receiving Docetaxel.Poster Session Abstracts. 2009; (1114): 1114https://doi.org/10.1158/0008-5472.SABCS-09-1114
- A prospective randomized controlled trial of hydrating nail solution for prevention or treatment of onycholysis in breast cancer patients who received neoadjuvant/adjuvant docetaxel chemotherapy.Breast Cancer Res Treat. 2017; 164: 617-625https://doi.org/10.1007/s10549-017-4268-7
- Pain: a review of three commonly used pain rating scales.J Clin Nurs. 2005; 14: 798-804https://doi.org/10.1111/j.1365-2702.2005.01121.x
- Sample size tables for exact single-stage phase II designs.Stat Med. 2001; 20: 859-866https://doi.org/10.1002/sim.721
- Matched case-control phase 2 study to evaluate the use of a frozen sock to prevent docetaxel-induced onycholysis and cutaneous toxicity of the foot.Cancer. 2008; 112: 1625-1631https://doi.org/10.1002/cncr.23333
- Management and Outcome of Taxane-Induced Nail Side Effects: Experience of 79 Patients from a Single Centre.Skin Appendage Disord. 2019; 5: 276-282https://doi.org/10.1159/000497824
Article info
Publication history
Accepted:
March 3,
2023
Received in revised form:
February 23,
2023
Received:
November 23,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Declaration of interest: None
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
