Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Int J Dermatol. 2021 Feb;60(2):179-184. doi: 10.1111/ijd.15099. Epub 2020 Sep 25.
High rates of posttreatment discomfort, infection, recurrence, and increased time to return to work have been noted after nail plate avulsion resulting from epidermal growth factor receptor tyrosine kinase inhibitor(EGFR-TKI)-induced paronychia, which may even interrupt the course of treatment for EGFR-TKI therapy. Thus, we conducted this study to determine how effectively a topical β-blocker, betaxolol, prevents EGFR-TKI-induced paronychia.
This case-control cohort study included a total of 131 non-small-cell lung cancer patients. The prevention group comprised 40 patients treated with topical betaxolol 0.25% solution to prevent paronychia while they received EGFR-TKI therapy. The control group comprised 91 patients who did not preventively use topical betaxolol 0.25% solution while receiving EGFR-TKI therapy. The patients' age, gender, antineoplastic regimen, duration of antineoplastic treatment before the appearance of lesions, number of involved digits (fingernails or toenails) with lesions, grading of paronychia, and pain score were recorded.
In terms of the cumulative incidence of paronychia, significant differences (P < 0.01) were noted at both the 2nd and 3rd months after starting EGFR-TKIs. Furthermore, the average visual analogue scale scores were 3.125 and 6.29 in the prevention group and control group, respectively (P < 0.01). The average grades of paronychia were 1.5 and 2.12 in the prevention group and control group, respectively (P < 0.01). The average numbers of involved digits were 2.25 (range: 1-5 digits) in the prevention group and 3.03 (range: 1-7) in the control group (P = 0.07).
Preventively using topical betaxolol can significantly decrease the incidence, VAS score, and grading of EGFR-TKI-induced paronychia.
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）诱导的甲沟炎导致指甲板拔脱后，患者在治疗后会出现较高的不适、感染、复发率，且重返工作岗位的时间延长，甚至可能中断 EGFR-TKI 治疗过程。因此，我们进行了这项研究，以确定局部使用β受体阻滞剂倍他洛尔（betaxolol）是否能有效预防 EGFR-TKI 诱导的甲沟炎。
这是一项病例对照队列研究，共纳入 131 例非小细胞肺癌患者。预防组 40 例患者在接受 EGFR-TKI 治疗时使用 0.25%倍他洛尔局部溶液预防甲沟炎，对照组 91 例患者在接受 EGFR-TKI 治疗时未预防性使用 0.25%倍他洛尔局部溶液。记录患者的年龄、性别、抗肿瘤方案、开始出现病变前的抗肿瘤治疗持续时间、病变累及的指甲（手指甲或脚趾甲）数量、甲沟炎分级和疼痛评分。
在开始使用 EGFR-TKIs 的第 2 个月和第 3 个月，两组的甲沟炎累积发病率存在显著差异（P<0.01）。此外，预防组和对照组的平均视觉模拟量表评分分别为 3.125 和 6.29（P<0.01）。预防组和对照组的甲沟炎平均分级分别为 1.5 级和 2.12 级（P<0.01）。预防组受累指甲数量平均为 2.25 个（范围：1-5 个指甲），对照组为 3.03 个（范围：1-7 个指甲）（P=0.07）。
预防性使用局部倍他洛尔可显著降低 EGFR-TKI 诱导的甲沟炎的发生率、视觉模拟量表评分和分级。
