Prevention and Treatment of Chemotherapy-Induced Alopecia: What Is Available and What Is Coming?
, Nicole I. Haberland, Aysun Akhundlu, Andrea Laboy Nieves and Mariya Miteva
Round 1
Reviewer 1 Report
Although the authors report no conflicts of interest, there is a heavy focus on cooling devices. Perhaps they could reconfirm this lack of conflict of interest.
Some reediting requires to be done as noted below for the authors:
1. Low intensity ultrasound (page 4) -
Probably best moved to the treatment section, given the experimental use in treating (not preventing) metabolic effects of paclitaxel. It should also be placed as a separate subsection. This did not happen in page 4
2. CG428 lotion -
This would be considered under CAM therapies and should be moved there, given the composition of the lotion. In consequence, the assertion that there is not sufficient evidence should be removed. Reference 98 (JAAD, 2019) appears to provide some reasonable evidence
3. Given the short discussion on cyclosporine, what about topical calcineurin inhibitors? Perhaps references below may help?
Gamret AC, Potluri VS, Krishnamurthy K, Fertig RM. Frontal fibrosing alopecia: efficacy of treatment modalities. Int J Womens Health. 2019 Apr 29;11:273-285. doi: 10.2147/IJWH.S177308.
Barton VR, Toussi A, Awasthi S, Kiuru M. Treatment of pediatric alopecia areata: A systematic review. J Am Acad Dermatol. 2022 Jun;86(6):1318-1334. doi: 10.1016/j.jaad.2021.04.077. Epub 2021 Apr 30. PMID: 33940103;
Author Response
We would like to thank the Reviewers and Editor for their helpful comments and suggestions. Please kindly find our point-by-point response in the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
This is a well written article about prevention and Treatment of Chemotherapy-induced Alopecia. I seuggest in the point 2.4 to expand the part regarding PRP, that is a mini-invasivi e new methods for aloepcia induced also by chemotherapic agents. In this regards, please read and add these recent articles: PMID: 34577827 and PMID: 33806169
Finally, explain better the pathogenesis of alopecia induced by chemotherapic agents.
Thank you
Author Response
We would like to thank the Reviewers and Editor for their helpful comments and suggestions. Please kindly find our point-by-point response in the attachment.
Author Response File: Author Response.pdf
Reviewer 3 Report
page 2. 40% of pCIA is not what is observed in clinic and varied according to the dose of docetaxel (this is based on a small study and case reports) page 3: authors mention they review the options for CIA. Was it a systematic review? If not, why? Page 3: authors mention efficacy of scalp cooling of 50-70% but it depends if chemotharapy type (e.g. low for antracyclines-taxanes, high for taxanes alone). Table 2: column masking-open label, not clear Table 2:clolumn enrollement: target sample size? In the discussion, author could add that a drawback, in addition to cost (e.g. in country with "free healthcare"-is the extra time needed for the patient to stay in the chemotherapy room.Author Response
We would like to thank the Reviewers and Editor for their helpful comments and suggestions. Please kindly find our point-by-point response in the attachment.
Author Response File: Author Response.pdf
Reviewer 4 Report
It is without question that chemotherapy-induced alopecia (CIA) constitutes a significant challenge for those undergoing cancer chemotherapy. The Authors astutely point out that many individuals would, if given the choice, prefer to lose an appendage such as their breast over loss of hair. Likewise, the Reviewer is positively impressed by the scope of therapeutic options well-described and presently available to address the onset and progression of CIA. Here, however, the Reviewer finds absent a number of relevant and useful data points.
1. While addressing vitamin D (calciferol) the role of vitamin D receptor (VDR) has been well established and extensively studied in the hair cycle. Its deficiency is also closely linked to several types of alopecia, including alopecia areata, telogen effluvium, and androgenetic alopecia (AGA).
2. Lantanoprost (analog of prostaglandin F2α) represents a potent ornithine decarboxylase inhibitor -- contradistinct from other ameliorative agents -- the drug’s mechanism is consequential and should be noted and described in the text.
3. Spironolactone, a small molecule which inhibits circulating testosterone (T) operates by occupying the androgen receptor AR and thereby displacing androgenic metabolites such as 5 alpha-dihydrotestosterone (DHT), thus limiting the potential translocation and subsequent activation within nuclear transcription DNA-binding domains. Due to its profoundly estrogenic potential, spironolactone is not indicated for use by males.
Each of the aforementioned should be incorporated in the body of this work.
Author Response
We would like to thank the Reviewers and Editor for their helpful comments and suggestions. Please kindly find our point-by-point response in the attachment.
Round 2
Reviewer 3 Report
My comments have been replied to satisfaction except the methodology of the review. The authors say in their responses to comments
"This is a systematic review of current clinical trials to prevent and treat CIA, as well as approaches that have been shown effective to treat other types of alopecia which may merit further investigation for their efficacy to prevent or treat CIA. "
However, a systematic review follows the PRISMA guidelines which is not the case here. Please clarify the methology of the review. Thanks
Author Response
Thank you for your comments and clarification. I am sorry for the confusion. Our review is not a systematic review following the PRISMA Guidelines. It was based on a search of clinical trials on chemotherapy-induced alopecia in the clinicaltrials.gov database on Jan. 25th, 2023, all 32 of them, and a literature review of approaches that may prevent alopecia or promote hair regrowth after chemotherapy which are currently being assessed and those we think should be assessed that may benefit chemotherapy patients.
