-
Zhonghua Yu Fang Yi Xue Za Zhi [Chinese... Jan 2022The epidermal growth factor receptor (EGFR) signaling is aberrantly overexpressed in many solid malignancies, making it an important target for anti-cancer biologic... (Review)
Review
The epidermal growth factor receptor (EGFR) signaling is aberrantly overexpressed in many solid malignancies, making it an important target for anti-cancer biologic agents. Among them, epidermal growth factor receptor inhibitors (EGFRIs), which have been widely used in clinical practice, include anti-EGFR monoclonal antibodies and tyrosine kinase inhibitors. A proportion of patients treated with EGFRIs develop specific, dose-dependent skin toxicity such as papulopustular rash, paronychia, xerosis and itch. These side effects can cause physical and psychosocial discomfort that may result in dose reduction, discontinuance, or replacement of the current EGFRIs treatment. Correct diagnosis and treatment of these skin and mucosal adverse effects associated with EGFRIs is of great significance for the tertiary prevention of malignant tumors. A review on EGFRI-related mucocutaneous adverse reactions is presented here, focusing on the pathogenesis, the various clinical manifestations, the strategies for prevention and treatment of these conditions.
Topics: Antibodies, Monoclonal; Antineoplastic Agents; ErbB Receptors; Humans; Neoplasms; Protein Kinase Inhibitors
PubMed: 35092997
DOI: 10.3760/cma.j.cn112150-20210601-00528 -
JTO Clinical and Research Reports Dec 2023Osimertinib may be effective in treating central nervous system (CNS) metastasis, but its efficacy in treating radiation therapy (RT)-naive metastasis is unclear. The...
A Phase 2 Single-Arm Study of Osimertinib for Radiotherapy-Naive Central Nervous System Metastasis NSCLC: Results for the First-Line Cohort of the OCEAN Study (LOGIK 1603/WJOG 9116L).
INTRODUCTION
Osimertinib may be effective in treating central nervous system (CNS) metastasis, but its efficacy in treating radiation therapy (RT)-naive metastasis is unclear. The OCEAN study assessed the efficacy of osimertinib against RT-naive CNS metastasis in patients previously treated (T790M cohort) and untreated patients (first-line cohort) with mutation. Here, we report the results of the first-line cohort.
METHODS
Previously untreated patients with RT-naive CNS metastasis and mutation-positive NSCLC were treated with osimertinib. The brain metastasis response rate (BMRR), progression-free survival (PFS), and overall survival in the first-line cohort were secondary end points.
RESULTS
A total of 26 patients were enrolled in the study between September 2019 and July 2020. The median age was 72.0 years with 80.8% female. There were 20 patients who had multiple CNS metastases. BMRR assessed by PAREXEL criteria was 76.9% (90% confidence interval [CI]: 63.3%-90.5%), BMRR assessed by Response Evaluation Criteria in Solid Tumors was 76.9% (95% CI: 54.0%-99.8%), and median PFS of CNS metastasis was 22.0 months (95% CI: 9.7 mo-not reached). The overall response rate was 64.0% (95% CI: 45.2%-82.8%), median PFS was 11.5 months (95% CI: 6.9 mo-not reached), and median survival time was 23.7 months (95% CI: 16.5 mo-not reached). Paronychia and increased creatinine level were the most frequent nonhematological toxicities observed in 13 patients (50%). Grade three and higher adverse events were less than 10%, and there were no treatment-related deaths. Pneumonitis was observed in five patients (19.2%).
CONCLUSIONS
These results suggest that osimertinib is effective in untreated patients with RT-naive asymptomatic CNS metastasis in a clinical practice first-line setting.
TRIAL REGISTRATION
UMIN identifier: UMIN000024218. jRCT identifier: jRCTs071180017.
PubMed: 38046380
DOI: 10.1016/j.jtocrr.2023.100587 -
The Journal of Dermatological Treatment Aug 2019Neratinib is a tyrosine kinase inhibitor that was FDA-approved for extended adjuvant treatment in adults with human epidermal growth factor receptors-2 (HER-2) positive...
Neratinib is a tyrosine kinase inhibitor that was FDA-approved for extended adjuvant treatment in adults with human epidermal growth factor receptors-2 (HER-2) positive breast cancer in 2017. Due to the novelty of the drug, there are no current reports in the literature of adverse cutaneous effects associated with neratinib therapy. We present a case of a woman on neratinib for HER-2 positive infiltrating ductal carcinoma of the right breast who presented to the dermatology clinic with changes to the fingernails, acne, and a rash on the face. Physical examination revealed erythema, induration, and some serum crust along the lateral nail folds of the right fourth and left third digits as well as monomorphic acneiform papules and pustules on the face. The timeline of the patient's paronychia and acneiform rash were consistent with a diagnosis of neratinib-associated skin changes. The patient was prescribed doxycycline to control the acneiform eruption. For the nails, she used mupirocin ointment as well as Listerine soaks. She experienced great improvement on this regimen at her 3-month follow-up visit. This case highlights similar cutaneous side effects to epidermal growth factor receptor (EGFR) inhibitors with a newer agent, neratinib, that have not been documented in the literature.
Topics: Acneiform Eruptions; Adult; Antineoplastic Agents; Breast Neoplasms; Carcinoma, Ductal, Breast; Drug Eruptions; Female; Humans; Protein Kinase Inhibitors; Quinolines; Receptor, ErbB-2
PubMed: 30321080
DOI: 10.1080/09546634.2018.1536253 -
Journal of Oncology Pharmacy Practice :... Sep 2023Painful paronychia and pseudopyogenic granuloma (PG) are common adverse drug reactions (ADRs) associated with the use of epidermal growth factor receptor tyrosine kinase...
Combination of available topical beta-blockers and antibiotic ointment for epidermal growth factor receptor tyrosine kinase inhibitor-induced paronychia and pseudopyogenic granulomas in Taiwan.
BACKGROUND
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
Topics: Humans; Female; Aged; Male; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Tyrosine Kinase Inhibitors; Timolol; Angiolymphoid Hyperplasia with Eosinophilia; Retrospective Studies; Anti-Bacterial Agents; Paronychia; Ointments; Taiwan; Protein Kinase Inhibitors; Neomycin; ErbB Receptors; Tyrothricin; Ophthalmic Solutions; Mutation
PubMed: 36112905
DOI: 10.1177/10781552221122051 -
Medicine Oct 2022The development of targeted therapy has improved treatment outcomes for patients with non-small cell lung cancer (NSCLC). However, paronychia, a common adverse effect of...
The development of targeted therapy has improved treatment outcomes for patients with non-small cell lung cancer (NSCLC). However, paronychia, a common adverse effect of targeted therapy, remains burdensome. Although conservative treatments for paronychia have been well reported in the literature, studies on the efficacy of surgical partial matricectomy for paronychia, are scarce. This study aimed to evaluate the effect of surgical partial matricectomy in targeted therapy-induced paronychia in patients with NSCLC. This retrospective cohort study included 11 patients with a total of 18 lesions on the big toes. Data on lung cancer stages, types and duration of targeted therapy, onset of paronychia, pain scale scores, conservative treatments, course of matricectomy, paronychia-free interval after matricectomy, and wound condition were collected from medical records. The Wilcoxon signed-rank test was used for analysis. The mean pain scale score after matricectomy was significantly lower than that after conservative treatments (1.00 ± 0.00 vs 2.94 ± 0.87; P < .001) and before treatment (1.00 ± 0.00 vs 3.06 ± 0.80; P < .001). The mean duration of matricectomy was significantly shorter than that of conservative treatments (3.22 ± 1.00 vs 56.56 ± 52.29 weeks; P < .001). Surgical partial matricectomy is an effective and enduring intervention for targeted therapy-related paronychia. It provides a shorter course of treatment, reduced pain, and improved appearance of the healed wound. Furthermore, surgical partial matricectomy could result in a better quality of life during targeted therapy than that of conservative treatments.
Topics: Humans; Retrospective Studies; Carcinoma, Non-Small-Cell Lung; Quality of Life; Lung Neoplasms; Paronychia; Pain
PubMed: 36281135
DOI: 10.1097/MD.0000000000031208 -
Journal of Oncology Pharmacy Practice :... Sep 2022Pemphigus Vulgaris is a rare, noncommunicable, non-hereditary fatal autoimmune dermatological manifestation in which a painful blister initiates from the oral cavity....
Pemphigus Vulgaris is a rare, noncommunicable, non-hereditary fatal autoimmune dermatological manifestation in which a painful blister initiates from the oral cavity. PRIDE complex stands for Papulopustules or paronychia, regulatory abnormality of hair and nails, itching, and dryness due to inhibition of EGFR. Both of these mucocutaneous manifestations are rare and are often caused by drugs. Our case reports 53-year-old patient presented with multiple crusted plaques, multiple hyperpigmented macules to patches, Solitary fluid-filled lesions on several parts of the body, and numerous erosions positive over buccal mucosa on initial follow up which was diagnosed as Pemphigus Vulgaris with PRIDE complex induced by Gefitinib. The patient was treated with almost all possible treatment options, i.e., both steroids plus adjuvant therapy for pemphigus and antihistaminic, antibiotics, moisturizer, and lotions for PRIDE complex. The patient was initially admitted for infusion of the first dose of rituximab and later for management of flare-up condition and infusion of the second dose of rituximab infusion. The complexity of the management of Pemphigus Vulgaris and PRIDE complex demands adequate monitoring of the patient's anti-cancerous therapy by clinical pharmacists, which can impact the clinical outcomes by providing pharmaceutical care and minimize the economic burden.
Topics: Gefitinib; Humans; Middle Aged; Pemphigus; Rituximab; Steroids
PubMed: 35102778
DOI: 10.1177/10781552221076755 -
The Journal of Dermatological Treatment Jun 2022Although Americans seek care for their nail diseases on an outpatient basis, they also seek nail care in the setting of the emergency department (ED).
BACKGROUND
Although Americans seek care for their nail diseases on an outpatient basis, they also seek nail care in the setting of the emergency department (ED).
PURPOSE
This study aims to characterize the treatment of nail diseases at ED visits in the United States from 2009-2018.
METHODS
Data from 2009-2018 was collected from the National Hospital Ambulatory Medical Care Survey for EDs.
RESULTS
There was an estimated 1.54 (95% CI [1.35, 1.74]) million nail visits to the ED from 2009-2018. Whites accounted for the most visits (57%), followed by African Americans (21%). 25-44-year-olds was the age group with the most visits. The South was the region with the most visits (33%). The most common diagnosis was paronychia (42%). Treatments for paronychia included oral antibiotics, incision and drainage, or both.
LIMITATIONS
The accuracy of reporting the correct diagnosis remains the biggest limitation.
CONCLUSIONS
Nail disease visits accounted for over a million visits to the ED from 2009-2018. All ages and sexes were represented in these visits. Paronychia made up the largest portion of visits and was treated with oral antibiotics, incision and drainage, or both.
Topics: Ambulatory Care; Anti-Bacterial Agents; Emergency Service, Hospital; Health Care Surveys; Humans; Paronychia; United States
PubMed: 34289796
DOI: 10.1080/09546634.2021.1959503 -
Journal of Traditional and... Sep 2020Cancer is a major public health problem worldwide, and there has been a sustained rise in its incidence in both developing and developed countries. Although there are... (Review)
Review
Cancer is a major public health problem worldwide, and there has been a sustained rise in its incidence in both developing and developed countries. Although there are currently numerous effective therapeutic options for cancer, they sometimes exhibit resistance and obvious side effects. Traditional Chinese medicine (TCM) currently plays a major role in cancer therapy by downregulating the growth of cancer cells through various pathways and by relieving side effects. Studies in cultured human malignant cell lines have demonstrated that can control cancer cell proliferation and cancer progression by inducing autophagic and apoptotic cell death. Case-control studies have indicated that TCM can relieve the side effects of cancer therapy. This review provides brief insights into the anticancer effects of TCM, the side effects relieved by TCM, and the role of TCM doctors in cancer treatment.
PubMed: 32953557
DOI: 10.1016/j.jtcme.2019.07.001 -
Journal of the American Academy of... Dec 2020Carpal tunnel syndrome (CTS) is commonly seen by general practitioners and often presents with neurologic symptoms of nocturnal pain and paresthesia along the median... (Review)
Review
Carpal tunnel syndrome (CTS) is commonly seen by general practitioners and often presents with neurologic symptoms of nocturnal pain and paresthesia along the median nerve distribution. Approximately 20% of patients also present with cutaneous findings (ulcerations, blistering, sclerodactyly, nail dystrophy) characterizing a severe form called necrotic CTS. Necrotic CTS can also be associated with bone changes (acro-osteolysis). In the author's practice, combined nail and skin findings are not an uncommon presentation of CTS, although this form remains overlooked and underreported in the dermatological textbooks and studies. This manuscript aims to review the literature on CTS cases, with a specific focus on using associated nail findings as diagnostic clues. The literature review along with a few additional recent cases from the author's practice demonstrate that CTS is frequently accompanied by a variety of nail changes including koilonychia, longitudinal fissuring, Beau's lines, onychomadesis, melanonychia, nail thickening, hyperkeratosis, and ischemic ulcerations with paronychia. Furthermore, when these changes are limited to the second and third fingernails, they should prompt the diagnosis of CTS. Once suspected, diagnostic evaluation is not difficult and surgical management can resolve cutaneous findings and prevent irreversible changes such as acro-osteolysis.
Topics: Administration, Topical; Carpal Tunnel Syndrome; Decompression, Surgical; Fingers; Glucocorticoids; Humans; Injections, Intralesional; Median Nerve; Nails; Nails, Malformed; Necrosis; Nitroglycerin; Severity of Illness Index; Splints; Treatment Outcome
PubMed: 32199899
DOI: 10.1016/j.jaad.2020.03.023 -
International Journal of Dermatology Jun 2024Pemphigus is a group of autoimmune mucocutaneous bullous disorders characterized by acantholysis resulting from autoantibodies targeting epithelial cell surface... (Review)
Review
Pemphigus is a group of autoimmune mucocutaneous bullous disorders characterized by acantholysis resulting from autoantibodies targeting epithelial cell surface antigens. Studies reflect the presence of nail manifestations in some patients and suggest a potential correlation with clinical severity. This study examines the overall prevalence and characterizes the diverse manifestations of nail changes in pemphigus. We searched Cochrane, MEDLINE, EMBASE, and LILACS from 1990 to June 26, 2023 for studies reporting different nail changes in pemphigus patients. Data were collected and pooled to obtain proportions of the prevalence of nail changes in patients with pemphigus and subgroup analysis for pemphigus foliaceous and pemphigus vulgaris. The risk of bias was assessed with the Joanna Briggs Institute Checklist. Of 321 studies screened, 14 studies with 1,208 patients were included. Paronychia (n = 185) and Beau's lines (n = 104) were the most common nail changes identified. The pooled prevalence of nail disease in pemphigus patients was 0.389 (number of studies; [95% CI]: n = 9; [0.160-0.680], with high heterogeneity between studies (I = 95.0%, P < 0.001). Subgroup analysis revealed the highest prevalence in pemphigus foliaceous at 0.342 (n = 3; [0.109-0.688]) and pemphigus vulgaris at 0.396 (n = 5; [0.114-0.769]). Nail changes exhibited varied temporal relationships with disease onset and flares, preceding, concurrent, or following these events. Correlation with disease severity was noted, although discrepancies between studies were reported. Nail changes in pemphigus, particularly pemphigus vulgaris and pemphigus foliaceous, may be underrecognized. Observations regarding temporal associations and potential correlations with disease severity highlight the diagnostic and prognostic implications of nail changes in pemphigus. The limitations of this study include study heterogeneity and possible bias. Further research to establish the correlation of the presence and severity of nail changes on the overall disease course would be helpful.
PubMed: 38887088
DOI: 10.1111/ijd.17257