# 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

## TL;DR

Topical beta-blockers show high effectiveness in treating skin issues caused by EGFR inhibitors, with good safety and some subgroups showing lower response rates.

## Contribution

This is the first systematic review and meta-analysis evaluating the efficacy of topical beta-blockers for EGFR inhibitor-related paronychia and PGLs.

## Key findings

- Topical beta-blockers achieved a high overall response rate (94%) in treating EGFR inhibitor-related skin issues.
- Lung cancer patients and those using solution formulations had lower complete response rates.
- No adverse events were reported, suggesting good safety of the treatment.

## Abstract

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.

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.

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
2 = 69%) and CRR of 0.34 (CI 0.15–0.57, I
2 = 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.

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.

The meta‐analysis, involving with 96 patients, shows high overall response rate with favorable safety to use topical beta‐blockers for epidermal growth factor receptor inhibitors‐induced periungual side effects. Subgroups of lung cancer or solution formation had lower complete response rate, while tyrosine kinase inhibitor and female patients had negative associations.