Chemotherapy-induced alopecia in ovarian cancer patients: A systematic review of platinum-based combination regimens

Summary: Abstract Body: Ovarian cancer is the fifth most common cancer among women, with an estimated 19,680 new cases projected in 2024. Chemotherapy with platinum-based compounds (PB), such as carboplatin and cisplatin, remains the standard of care, often combined to other agents to enhance therapeutic efficacy. However, combination regimens significantly increase the risk of side effects, including chemotherapy-induced alopecia (CIA). A systematic review of studies indexed on PubMed investigating PB combination regimens in ovarian cancer cohorts was undertaken, focusing on CIA incidence and severity. Our analysis identified triple combination therapies as causing the most severe alopecia (grade 3-4) with cisplatin, paclitaxel, and lonidamine leading to severe CIA in 94% of patients. Similarly, the combination of cisplatin with cyclophosphamide and adriamycin, and cisplatin with gemcitabine and paclitaxel, resulted in severe alopecia in 76% and 43.5% of patients, respectively. PB-paclitaxel combinations resulted in CIA (grade 1-4) in as high as 90% of patients, while PB-cyclophosphamide regimens resulted in alopecia in up to 79%. In contrast, PB-gemcitabine combinations resulted in a lower incidence of moderate alopecia (14.3-21.4%), while PB combined to pegylated liposomal doxorubicin exhibited the lowest rate (7-34%). Notably, mild-to-moderate alopecia was reported in all patients treated with docetaxel and PB combination therapy. Further studies should explore alternative dosing strategies, evaluate emerging low-toxicity regimens, and assess supportive care measures aimed at minimizing the severity of alopecia. Ultimately, improving the management of CIA can enhance not only the physical well-being but also the emotional and social quality of life of ovarian cancer patients. Simonetta I. Gaumond^{1, 2}, Gabriela E. Beraja¹, Isabella Kamholtz¹, Lina M. Ferrari¹, Joaquin J. Jimenez^{1, 2} 1. Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, United States. 2. Department of Biochemistry and Molecular Biology, University of Miami Miller School of Medicine, Miami, FL, United States. Clinical Research: Epidemiology and Observational Research