Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan.
Division of Integrated Oncology, Institute of Biomedical Research and Innovation, Kobe, Japan.
Oncology. 2018;95(4):251-256. doi: 10.1159/000490177. Epub 2018 Jun 14.
The purpose of the study was to evaluate the site of paronychia in patients with non-small cell lung cancer harboring an epidermal growth factor receptor (EGFR) gene activating mutation who were treated with EGFR tyrosine kinase inhibitors (EGFR TKIs).
The study included 55 patients with non-small-cell lung cancer who were treated with an EGFR TKIs. Resulting all toxicities were graded using the Common Terminology Criteria for Adverse Events version 4.0 system. Drug concentrations were determined with use of a quantum triple-quadrupole mass spectrometer and dried blood spots testing.
Paronychia most commonly occurred in the thumb and the big toe. There was no correlation between the severity of paronychia and the drug concentration of each EGFR TKI at the site of paronychia. The mean penetration rates of the drug from plasma to the tip of the finger and toe were 74.1% (erlotinib), 82.2% (gefitinib), and 99.9% (afatinib).
High concentrations of an EGFR TKI at the affected site did not play a role in the onset mechanism of paronychia. Therefore, educating patients about ways to avoid compression may be a better approach to managing this adverse event than reducing the dose of the EGFR-TKI or stopping treatment.
本研究旨在评估表皮生长因子受体（EGFR）基因激活突变的非小细胞肺癌患者接受 EGFR 酪氨酸激酶抑制剂（EGFR-TKIs）治疗时发生甲沟炎的部位。
本研究纳入了 55 例接受 EGFR-TKIs 治疗的非小细胞肺癌患者。采用不良事件通用术语标准 4.0 版系统对所有毒性进行分级。采用量子三重四极杆质谱仪和干血斑检测法测定药物浓度。
甲沟炎最常发生在拇指和大脚趾。甲沟炎部位的 EGFR-TKI 药物浓度与甲沟炎的严重程度之间无相关性。药物从血浆到指尖和趾尖的平均穿透率分别为 74.1%（厄洛替尼）、82.2%（吉非替尼）和 99.9%（阿法替尼）。
受影响部位 EGFR-TKI 的高浓度与甲沟炎的发病机制无关。因此，与降低 EGFR-TKI 剂量或停止治疗相比，教育患者避免受压可能是管理这种不良反应的更好方法。
