Prophylactic management for taxane‐induced nail toxicity: A systematic review and meta‐analysis

Abstract

Objective This meta‐analysis was performed to assess the efficacy of cryotherapy and nail solution (NS) use in preventing nail toxicity (NT) induced by taxane‐based chemotherapy. Methods PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov registry databases were searched for relevant studies published up to December 2018. The primary outcome was taxane‐induced NT. Secondary outcomes were skin toxicity (ST), time to toxicity and patient comfort. Results We reviewed three randomised control trials and six prospective studies with 708 patients. For meta‐analysis, taxane‐induced NT grading was compared. NT and ST were significantly lower in the cryotherapy patients than in the controls (grade 1 NT: risk ratio [RR] = 0.51, 95% confidence interval [CI] = 0.30–0.89; grade 2–3 NT: RR = 0.36, 95% CI = 0.11–1.12; total NT: RR = 0.49; 95% CI = 0.30–0.79; ST: RR = 0.46, 95% CI = 0.33–0.64). The NS‐treated patients exhibited significantly lower NT than the controls. Conclusions Nail solution‐treated or cryotherapy patients exhibited lower NT incidence and severity associated with taxane‐based chemotherapy than the controls. For patients who can afford and comply with NS use or cryotherapy, these measures represent effective prophylactic management for taxane‐induced NT and improve their quality of life and functional statuses. Further studies are needed to establish the routine usage protocols, long‐term efficacy and safety for these interventions.

A rare case of Lindsay’s nails in a patient treated with paclitaxel for breast cancer

“…Nail apparatus injuries are often painful and lead to the development of infections, while peripheral neuropathy may cause highly unpleasant sensory experiences, as in our patient, and sometimes also result in muscle weakness [11]. It has become a great challenge for dermatologists and oncologists to search for methods that prevent the development of nail apparatus changes and thus improve the quality of life of patients [12]. Peyton et al [11] suggested that cooling (a factor causing vasoconstriction, typically at temperatures in the range of -25°C to -30°C) of the toksycznego wpływu tej grupy leków na paznokcie u dwóch pacjentek chorujących na raka jajnika, u których zastosowano paklitaksel w połączeniu z cisplatyną.…”

“…Uszkodzenia aparatu paznokciowego często są bolesne i prowadzą do rozwoju infekcji, neuropatia obwodowa może powodować szczególnie nieprzyjemne dla chorych, podobnie jak u naszej pacjentki, zaburzenia czucia, a czasami także osłabienie siły mięśniowej [11]. Dużym wyzwaniem dla dermatologów i onkologów jest konieczność poszukiwania metod zapobiegania rozwojowi zmian aparatu paznokciowego, których zastosowanie poprawia komfort życia pacjentów [12]. Peyton i wsp.…”

“…Patients should undergo the procedure 15 minutes before the drug is administered, during drug administration, and 15 minutes afterwards. So-called nail solutions can also be used to prevent the development of nail apparatus changes secondary to taxane chemotherapy by reducing the concentration of substance P, an inflammation-inducing neurotransmitter which promotes nail apparatus damage [12]. In addition, certain ingredients of these formulations, including plant-based waxes or essential oils, are rich in phytochemicals with bioactive properties, especially antioxidant and anti-inflammatory characteristics.…”

“…In addition, certain ingredients of these formulations, including plant-based waxes or essential oils, are rich in phytochemicals with bioactive properties, especially antioxidant and anti-inflammatory characteristics. The postulated mechanism of action of these substances is based on the assumption that they protect cells from damage by acting on the nail bed [12]. Lindsay's nails ("half-and-half" nails) is a condition classified as a variant of apparent leukonychia.…”

The Effect of Nail Lacquer on Taxane-Induced Nail Changes in Women With Breast Cancer

“…12 Many side effects such as cardiotoxicity, nail toxicity, peripheral neuropathy, fluid retention syndrome, arthralgia, myelosuppression, and skin reactions caused by taxanes have been identified. [13][14][15][16] In the literature, several case reports described the effect of taxanes on nails which includes onycholysis, melanonychia, subungal hemorrhage, subungual hyperkeratosis, Beau's lines, and nail dystrophy. 4,6,[17][18][19] In this work, we represent a clinical observational study to evaluate the effect of cosmetic nail lacquer on taxane-induced nail changes in female patients diagnosed with breast cancer.…”