Department of Cancer Center, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung.
Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University, Kaohsiung.
J Oncol Pharm Pract. 2023 Sep;29(6):1374-1380. doi: 10.1177/10781552221122051. Epub 2022 Sep 15.
Painful paronychia and pseudopyogenic granuloma (PG) are common adverse drug reactions (ADRs) associated with the use of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) to treat non-small cell lung cancer (NSCLC). Multiple local management approaches have been tested with unsatisfactory results. We have introduced an occlusion therapy technique through which available topical drugs for longer than 2 years.
Based on the cancer registry and case management system of our hospital, from July 2019 to July 2020, we retrospectively enrolled patients with NSCLC who were treated with EGFR-TKIs and received applications of 0.5% timolol ophthalmic solution (TIMOPTOL XE 0.5%®) combined with a neomycin/tyrothricin ointment (®) using the occlusion method to treat paronychia or PG.
A total of 22 patients were enrolled, with a mean age of 66.5 years, most of whom were women (72.7%). Periungual lesion-related pain was reported by all patients, and periungual bleeding and PG were reported in 14% (3/22) and 64% (14/22) of patients, respectively. After the occlusion therapy application of timolol ophthalmic solution combined with neomycin/tyrothricin ointment twice daily, the overall response rate was 83.3%, including complete response in 18% (4/22) of cases and partial response in 68% (15/22) of cases.
We presented an occlusion method using available topical beta-blockers and antibiotic ointment for EGFR-TKI-induced paronychia and PG in Taiwan. The result is favorable. Further randomized control trial is urgent to validate our findings.
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）治疗非小细胞肺癌（NSCLC）时，常引起痛性甲旁脓肿和假化脓性肉芽肿（PG）等不良反应。目前已有多种局部治疗方法，但效果均不理想。我们采用一种封闭治疗技术，应用市售的局部外用药物，2 年以上。
回顾性分析 2019 年 7 月至 2020 年 7 月我院应用 EGFR-TKIs 治疗的 NSCLC 患者，采用 0.5%噻吗洛尔滴眼液（TIMOPTOL XE 0.5%®）联合新霉素/杆菌肽软膏（®）封闭治疗甲沟脓肿或 PG。
共纳入 22 例患者，平均年龄 66.5 岁，女性占 72.7%。所有患者均有甲周病变相关疼痛，14%（3/22）的患者有甲周出血，64%（14/22）的患者有 PG。每日两次 TIMOPTOL XE 0.5%®联合新霉素/杆菌肽软膏封闭治疗后，整体有效率为 83.3%，其中完全缓解 18%（4/22），部分缓解 68%（15/22）。
我们提出了一种在台湾地区应用市售局部β受体阻滞剂和抗生素软膏的 EGFR-TKI 诱导性甲旁脓肿和 PG 的封闭治疗方法，效果良好，需要进一步的随机对照试验来验证我们的研究结果。
