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

Eur J Cancer Care (Engl). 2019 Sep;28(5):e13118. doi: 10.1111/ecc.13118. Epub 2019 Jun 11.


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 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.

Keywords: chemotherapy; cryotherapy; frozen gloves; nail solution; nail toxicity; onycholysis; taxane.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Cryotherapy / methods*
  • Docetaxel / adverse effects
  • Humans
  • Nail Diseases / chemically induced
  • Nail Diseases / prevention & control*
  • Neoplasms / drug therapy*
  • Oils, Volatile / therapeutic use*
  • Onycholysis / chemically induced
  • Onycholysis / prevention & control
  • Paclitaxel / administration & dosage
  • Paronychia / chemically induced
  • Paronychia / prevention & control
  • Pigmentation Disorders / chemically induced
  • Pigmentation Disorders / prevention & control
  • Plant Oils / therapeutic use*
  • Taxoids / adverse effects*
  • Waxes / therapeutic use*


  • Oils, Volatile
  • Plant Oils
  • Taxoids
  • Waxes
  • Docetaxel
  • Paclitaxel