Clinical Trials for saving hair during chemo

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Hortense
Hortense Member Posts: 982
edited September 2014 in Just Diagnosed

For those just diagnosed and concerned about losing their hair during chemo, I would like to let you know that there is a clinical trial going on right now to determine if scalp cooling using Dignicaps is effective at preserving hair during chemotherapy. It is open to people with stage 1 or 2 breast cancers and the Dignicap treatment would be free. 

Information about Dignicaps:

http://www.medgadget.com/2013/06/dignicap-to-help-...

Plus a recent CBS TV News story about them: 

http://losangeles.cbslocal.com/2014/03/18/ucla-tes...

Below is the government webpage with information about the Dignicap Trials and where to contact the hospitals and doctors involved:

http://clinicaltrials.gov/ct2/show/NCT01831024

There are two locations in New York City, one in San Francisco and one in Winston-Salem, NC. The cost of using the Dignicaps as part of the trial is nothing. It is hoping to enroll 110 people by September 2014.

United States, CaliforniaSan Francisco, California, United States, 94115Contact: Hope S. Rugo, MD 415-353-7428 hrugo@medicine.ucsf.edu Principal Investigator: Hope S. Rugo, MD United States, New YorkNew York, New York, United States, 10065Contact: Tessa Cigler, MD 617-821-0726 tec9002@med.cornell.edu Principal Investigator: Tessa Cigler, MD New York, New York, United States, 10011Contact: Margarita Gilyadova, MD 212-367-0181 mgilyado@chpnet.org Principal Investigator: Paula Klein, MD United States, North CarolinaWinston-Salem, North Carolina, United States, 27157Contact: Susan A. Melin, MD 336-716-2839 smelin@wakehealth.edu Principal Investigator: Susan A. Melin, MD

Eligibility

Ages Eligible for Study: 18 Years and olderGenders Eligible for Study: FemaleAccepts Healthy Volunteers: No

Criteria

Inclusion Criteria:

  • Female patients >/= 18 years of age
  • Documented diagnosis of stage I or II breast cancer
  • A planned course of chemotherapy in the adjuvant or neoadjuvant setting with curative intent including one of the following regimens:
    • Doxorubicin 60 mg/m2 and cyclophosphamide 600 mg/m2 x 4 - 6 cycles IV every 2 - 3 weeks
    • Docetaxel 75 mg/m2 and cyclophosphamide 600 mg/m2 x 4 - 6 cycles IV every 3 weeks
    • Paclitaxel 80 mg/m2 weekly IV x at least 12 weeks with or without IV trastuzumab
    • Paclitaxel 175 mg/m2 IV every 2 weeks x 4 - 6 cycles (without an anthracycline)
    • Paclitaxel weekly and carboplatin AUC 2 weekly or AUC 6 every 3 weeks IV x 4 - 6 cycles and trastuzumab IV weekly or every 3 weeks
    • Docetaxel 75 mg/m2 and carboplatin AUC 6 IV every 3 weeks x 4 - 6 cycles and trastuzumab IV weekly or every 3 weeks
    • Targeted agents such as trastuzumab or lapatinib are allowed
  • Plan to complete chemotherapy within 6 months
  • At least two years out from the last chemotherapy causing hair loss with complete recovery of hair
  • Karnofsky performance status >/= 80%
  • Willing and able to sign informed consent for protocol treatment
  • Willing to participate in study procedures including having photographs of the head before the first cycle of chemotherapy and 1 month after the last chemotherapy
  • Willing to enroll in an extension protocol for follow up for 5 years following the end of chemotherapy treatment

Exclusion Criteria:

  • Patients with female pattern baldness resembling picture I-3 or higher on the Savin scale
  • Autoimmune disease affecting hair; e.g. alopecia areata, systemic lupus with associated hair loss
  • A history of whole brain radiation
  • Plans to use a chemotherapy regimen other than those specified in the inclusion criteria. Specifically, patients receiving a regimen including both an anthracycline and a taxane are not eligible for this trial (AC/T, EC/T, TAC, etc.)
  • Concurrent hormone therapy with chemotherapy. Hormone therapy should be used as indicated following completion of chemotherapy
  • Underlying clinically significant liver disease including active viral hepatitis with abnormal liver function tests >1.5 times the upper limit of normal, including alkaline phosphatase, AST, and total bilirubin. Patients with Gilbert´s disease (elevated indirect bilirubin only) will be eligible for participation.
  • Clinically significant renal dysfunction defined as serum creatinine > upper limit of normal.
  • A serious concurrent infection or medical illness which would jeopardize the ability of the patient to complete the planned therapy and follow-up
  • A history of persistent grade 2 (or higher) alopecia induced by prior chemotherapeutic regimens
  • Participation in any other clinical investigation or exposure to other investigational agents, drugs, device or procedure that may cause hair loss
  • Intercurrent life-threatening malignancy
  • A history of cold agglutinin disease or cryoglobulinemia.
  • Evidence of untreated or poorly controlled hyper or hypothyroidism
  • A history of silicon allergy
  • American Society of Anesthesiologist Class ≥3

Comments

  • curveball
    curveball Member Posts: 3,040
    edited March 2014

    There is also a Phase 1 trial for Calcitriol (a topical form of Vitamin D) in
    Adult Patients Receiving Chemotherapy for the Treatment of Breast Cancer. This trial is only open to patients with inoperable locally advanced or metastatic cancer, who will be treated with a taxane. The trial ID is NCT01588522.

  • jc254
    jc254 Member Posts: 439
    edited May 2014

    Hortense has posted some great information here about the dignicap trial.  If anyone is facing chemotherapy and lives near one of the trial sites I urge you to check it out.  There's a very good possibility you can save your hair. 

  • LJFarish
    LJFarish Member Posts: 5
    edited March 2014

    I am not real familiar with all the trials now on using a cap but do have my opinion. I was diagnosed with breast cancer at age 33 and again in the other breast at age 36.  I did not have chemo the first time as I had no involvement in my lymph nodes. I did not have a choice the 2nd time as it was in 6 lymph nodes and I also had a very aggressive cancer. I will never forget the worse part of this was the thought of losing my hair.  My doctor said I should not use one, a cap, as it could protect any cancer cells if there were any on my head. As important as my hair was, it was not nearly as important as my life.  My daughter was only 7 years old at the time. My daughter is now 39 and I am still fine and have lived life to the fullest. Losing your hair is temporary and if I had to do it again I would not change a thing. I did find out in February that I carry the breast cancer gene BRCA1 and am triple negative. In 1981 they did not have all of the tests they do today. I feel blessed that women can now be checked for this gene. My daughter was checked once my tests knew what she needed to be tested for and she is NEGATIVE for the gene. She will never have to worry about this any more than someone that does not have it in their family.  Do not be afraid to do this also if it is in your family. I wish they had this test when I was younger. But I feel blessed and women do not need to be afraid.  There is so much that can be done today.

  • Hortense
    Hortense Member Posts: 982
    edited March 2014

    LJFarish - I am so glad you are doing well, and very glad for you that your daughter is negative for BRAC1. The BRCA gene is scary. My cousin's wife's family has it and has been badly ravaged by the disease, to the point that her niece had both breasts and uterus removed at 24 so that she wouldn't have to worry. That is terrible decision for a young woman to have to make.

    I would just like to note for those reading this thread that breast cancer does not show up as scalp mets and that cold caps and scalp cooling methods have been used extensively and safely for many years in Europe. The FDA would not be allowing a clinical trial of Dignicaps if it thought there was a risk.

  • jc254
    jc254 Member Posts: 439
    edited March 2014

    Although temporary for most women, losing your hair is a devasting side effect of cancer treatment.  It may not be necessary.  I was treated at a top ranked NCI designated cancer center and used cold caps at the suggestion of my surgeon. In my opinion, there are far too many women who have no idea this option even exists.   It is my hope that in the not too distant future cold cap therapy will be FDA approved, covered by insurance and routinely offered to women undergoing chemotherapy. This will allow women, in consultation with their medical team, to decide if cold cap therapy is appropriate for them. This trial is an important step in that direction.   

  • TexasMusicLover
    TexasMusicLover Member Posts: 1
    edited April 2014

    I just asked my doctor about this today and she said that they didn't want to create a safe haven for the cancer cells in the head. Are these available in the US to try?!? Where would you buy? What does it cost? Thanks!

  • Hortense
    Hortense Member Posts: 982
    edited May 2014

    I am so sorry that I did not see your post. Yes, about 1000 or more in the USA have used cold caps successfully, and there are many more in Europe where they have been used for many years. Most of the time here the caps are rented, although I believe there is a brand for sale as well. My onco doctor at New York Presbyterian Hospital's Breast Center, who is the Director of the breast center and nationally renown and respected, believes in them and believes they are safe. She just finished participating in the national FDA trial for the Dignicap brand. I used Penguin Cold Caps. In England cold cap use is so well known and accepted that the country's National Health Insurance program covers them.

    There have been studies to see whether breast cancer cells show up in the scalp after cold caps were used and the percentage rate was so low as to be a non issue. Breast cancer cells have been studied extensively and when they come back as mets they show up in well known areas -  bones, lungs, brain, heart - not the scalp.

    I hope you are doing well in your treatment. Take care.

  • lakegenevagirl
    lakegenevagirl Member Posts: 5
    edited May 2014

    Like Hortense, I was a Cold Cap user and I kept my hair through five rounds of chemo (Taxotere/Cytoxan).  In fact, I have a vlog at www.ThatTimeIHadCancer.com.  Every entry that I have posted was filmed while I was undergoing chemo, and I doubt anyone would be able to tell that I experienced any hair loss at all (although my roots look atrocious... not among my top ten cancer complaints, but you know... still a thing)

    I used Penguin Cold Caps.  They were painful, and expensive, and complicated; but I am SO glad I used them.  As a young woman with breast cancer (I'm in my mid-twenties), and an actress; my hair is super important to me.  I literally list "great hair" as a special skill on my resume.  Keeping my hair was not a small thing.  I don't think I could have held on to my positive outlook without it.  

    If you're considering Dignicaps or Cold Caps or another cryotherapy system and have questions, definitely reach out.  I'm happy to talk honestly about my experiences. 

  • exbrnxgrl
    exbrnxgrl Member Posts: 12,424
    edited May 2014

    I would just like to note for those reading this thread that breast cancer does not show up as scalp mets...

    Cold caps are certainly worth looking into, but, although rare, bc can metastasize to the scalp. I'm not saying that this is a major risk but to say scalp mets do not happen with bc is not true.

  • muska
    muska Member Posts: 1,195
    edited May 2014

    I asked my doctor about cold caps before I started chemo. I was told it would be torture to freeze your scalp for 3 hours at a time. So I got a wig - before I even started chemo - and had it styled to match my natural color and haircut and shaved my head as soon as my hair started falling out.  I am still wearing it to work while my hair is growing back. Have never gotten so many compliments about my hair when I had my own. new hair is growing back thick and healthy.

    Looking back hair is a very small concern that pales in comparison to other problems we are all facing.

    BTW, most insurances in the US cover wigs for medically induced alopecia.

  • Hortense
    Hortense Member Posts: 982
    edited September 2014

    Hair was no small concern to me, and for many others. Being able to keep our hair was key to maintaining a positive attitude as we were fighting our disease. There was no medical reason not to keep our hair. 

    Using cold caps is uncomfortable, but certainly not torture. Torture to me would be seeing myself bald in the mirror. Torture would be to be one of the 4-5 % of patients who's hair does not grow back after chemo, or comes back very thinly. I have met people that has happened to and they are miserable about it. There is a less than 1% chance of scalp mets when cold caps are used. That made sense to me.

  • Meow13
    Meow13 Member Posts: 4,859
    edited September 2014

    If I am ever faced with chemo I would use cold caps however inconvenient or painful.

  • jc254
    jc254 Member Posts: 439
    edited September 2014

    I used them, kept my hair, and couldn't be happier.  Cold caps made a very stressful time in my life that much easier to deal with. 

  • mdg
    mdg Member Posts: 3,571
    edited September 2014


    I used them and kept my hair too.  I am grateful.  Not only did I keep my hair, but I kept my privacy and also avoided having to teach my then 4 year old son what cancer and chemo meant.  He is now 8 and does not know anything.  He has no scary vision in his head of "sick mommy" with no hair.  I will tell him when the time is right, but he can see I am fine and always have been.  I was able to go on about my normal life - go to the gym daily and get back to teaching aerobics a few weeks after finishing chemo.  No one knew I had BC unless I chose to tell them.  Went back to teaching aerobics with my usual long ponytail and didn't have to explain anything.  I saw work colleagues during chemo that had no idea I had cancer.  I was just not the kind of person that wanted others to know.  Cold caps helped me continue with my normal life and not feel pity for myself or see the looks of pity from other people.   I kept a positive attitude and I think attitude matters.  It also was not torture to use the caps.  I could not stand being cold and I feared I would not be able to tolerate the caps.  I did it with no problem.  It was easier than I thought it would be.  Sometimes I worried that the caps were not cold enough!  Ha!  That's funny coming from a girl that hates to be cold!  I highly recommend the caps.  I also say do your research and educate your doctors.  Most know little about them and just give false information and scare patients away from using them.  I had one MO argue with me that the caps don't work even though I was 2 months out of chemo with a full head of my own hair.  She basically acted like I was lying.  Don't let them intimidate you.  There are credible studies out there so read them for yourself and make your own decision. 

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