Efficacy of Topical Beta-Blockers in Managing Epidermal Growth Factor Receptor Inhibitor-Related Paronychia and Pyogenic Granuloma-Like Lesion: A Systematic Review and Meta-Analysis.

[INTRODUCTION] Epidermal growth factor receptor (EGFR) inhibitors, including tyrosine kinase inhibitors (TKIs), are associated with paronychia and pyogenic granuloma-like lesions (PGLs) that significantly impair patients' quality of life. Topical beta-blockers emerge as a non-invasive and promising therapy for such adverse events. This meta-analysis evaluated the efficacy of topical beta-blockers for EGFR inhibitor-induced paronychia and PGLs.

[METHOD] In accordance with the PRISMA 2020 guidelines, multiple databases were searched for relevant studies. The primary outcomes were overall response rate (ORR) and complete response rate (CRR) within 1 month. Secondary outcomes included safety outcomes and subgroup analyses, while meta-regression was performed to assess the moderating effects of baseline characteristics. R programming was used for analysis and plotting.

[RESULTS] Six studies involving 96 patients were included. Topical beta-blocker yielded a high pooled ORR of 0.94 (confidence interval, CI 0.81-1.00, I = 69%) and CRR of 0.34 (CI 0.15-0.57, I = 76%) within 1 month. Despite no significant between-group differences, lower CRR were found in lung cancer (0.35, 95% CI [0.12, 0.60]) and solution formation subgroup (0.30, 95% CI [0.06, 0.62]). Meta-regression identified negative trends in CRRs for female patients and TKI users (p < 0.1). No adverse event was reported.

[CONCLUSION] Our research concluded that topical beta-blockers may be a well-tolerated and beneficial option for managing EGFR inhibitor-induced paronychia and PGL. Additional and large-scale randomized controlled trials are necessary to confirm these findings, standardize treatment protocols, and evaluate long-term effectiveness.