Are topical beta-blockers really effective “in real life” for targeted therapy-induced paronychia

Sibaud, Vincent; Casassa, E.; D’Andrea, Mirella

doi:10.1007/s00520-019-04690-8

Cited by 18 publications

(10 citation statements)

References 18 publications

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“…It is conceivable that the lack of response might be caused by the cream vehicle, which was not adequate to penetrate into the thicker skin of the feet, or that the drug concentration was not appropriate. Sibaud and colleagues19 demonstrated a partial response in nearly two thirds of cancer patients (8/13) at 1-month evaluation. Our case series included nine patients with paronychia and pyogenic granuloma-like lesions of the fingernails and/or toenails which were treated with topical timolol 0.5% gel, twice daily, under occlusion, for 4 weeks.…”

Section: Resultsmentioning

confidence: 98%

“…No local or systemic adverse events were reported at the 1-month assessment and throughout the 8 months of follow-up. A retrospective, single-center study was recently published by Sibaud and colleagues19 who evaluated the efficacy of topical timolol 0.5% gel applied twice daily under occlusion in 13 patients treated with EGFR-I (four patients with lapatinib, four patients with afatinib, three patients with cetuximab and two patients with erlotinib). At 1-month evaluation, 2/13 (15%) patients achieved CR, defined as clearance of lesion, absence of pain and/or bleeding; 6/13 (46%) had a partial response with improvement in at least one of the three parameters; 5/13 (39%) did not have any clinical benefit.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy of topical beta-blockers in the management of EGFR-inhibitor induced paronychia and pyogenic granuloma-like lesions: case series and review of the literature

Sollena¹,

Mannino²,

Tassone³

et al. 2019

DIC

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Nail toxicities, such as paronychia and pyogenic granuloma-like lesions, are well-recognized side effects of epidermal growth factor receptor inhibitor (EGFR-I) therapy that can significantly impair patient’s quality of life and compliance to anticancer treatment. Numerous therapeutic options are available, with variable rates of success. Recently, topical β-blockers have emerged as a novel, non-invasive treatment strategy. We tested the effectiveness of topical timolol 0.5% gel, twice daily, under occlusion for 30 days, on paronychia and periungual pyogenic granuloma-like lesions in 9 patients being treated with EGFR-I. We also reviewed the available literature on this topic, which is the use of topical β-blockers in the management of EGFR-I-induced nail toxicities. We assessed 25 lesions consistent with the diagnosis of EGFR-I-induced pyogenic granuloma-like lesions and paronychia (21 diagnosed as pyogenic granuloma-like, and four as paronychia). Thirteen of the 25 lesions achieved complete resolution, 9/25 reached at least improvement, and only 3/25 did not respond to the intervention. As for the review, four papers met the scope of our research. The results confirmed at least partial benefit in the majority of treated patients. Among current strategies, high-potency topical corticosteroids are a well-known treatment option especially for paronychia, targeting the inflammatory component of such lesions; nevertheless, the management of pyogenic granuloma-like lesion is often more complex and the success rate is variable. Nail plate avulsion and phenol chemical matricectomy are not highly effective and display some degree of invasiveness. Topical β-blockers seem to be promising alternatives, especially in fragile cancer patients who may be unsuitable candidates for an invasive procedure.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Efficacy of topical beta-blockers in the management of EGFR-inhibitor induced paronychia and pyogenic granuloma-like lesions: case series and review of the literature

Sollena¹,

Mannino²,

Tassone³

et al. 2019

DIC

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“…In two relatively similar studies, Cubiró et al reported on 10 patients and Sibaud et al on 13 patients who were treated with timolol eye gel 0.5%, used twice daily under the dressing for up to a month. Eleven patients recovered, seven partially recovered, and five patients did not recover at all 39,40 . Yen et al 41 treated one patient fully with Betaxolol eye drop 0.25%, used under the dressing for 1 month.…”

Section: Timolol In Treating Vascular Lesionsmentioning

confidence: 99%

The role of topical timolol in wound healing and the treatment of vascular lesions: A narrative review

Goodarzi

Mozafarpoor

Dodangeh

et al. 2021

Dermatologic Therapy

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Beta-2 adrenergic receptors are the only subgroup of beta-adrenergic receptors expressed in the membrane of large cells, including skin keratinocytes, fibroblasts, and melanocytes. Alterations in the function or concentration of β2 adrenoreceptors related to keratinocytes are associated with some skin conditions. Some findings suggest the role of β2 adrenoreceptors in maintaining the function and integrity of the epidermis. Beta-receptor antagonists can be systemically and topically effective in healing hemangioma, paronychia, vasculitis ulcer, tufted angioma, acute and chronic wounds. Most studies with a strong design on this subject deal with the systemic form, but recently, numerous case and group reports and smaller studies have focused on topical forms, especially topical timolol. The present comprehensive review study surveys the role of topical timolol in acute and chronic wound healing in the field of dermatology.

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“… 78 , 79 Furthermore, topical treatments with propranolol and timolol, such as those developed for infantile hemangiomas, can also shorten the recovery time when applied to painful swelling around the nails that can develop after treatment with EGFR inhibitors. 80 …”

Section: Introductionmentioning

confidence: 99%

Repurposing approved drugs for cancer therapy

Schein

2021

British Medical Bulletin

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Background Many drugs approved for other indications can control the growth of tumor cells and limit adverse events (AE). Data sources Literature searches with keywords ‘repurposing and cancer’ books, websites: https://clinicaltrials.gov/, for drug structures: https://pubchem.ncbi.nlm.nih.gov/ Areas of agreement Introducing approved drugs, such as those developed to treat diabetes (Metformin) or inflammation (Thalidomide), identified to have cytostatic activity, can enhance chemotherapy or even replace more cytotoxic drugs. Also, anti-inflammatory compounds, cytokines and inhibitors of proteolysis can be used to control the side effects of chemo- and immuno-therapies or as second-line treatments for tumors resistant to kinase inhibitors (KI). Drugs specifically developed for cancer therapy, such as interferons (IFN), the tyrosine KI abivertinib TKI (tyrosine kinase inhibitor) and interleukin-6 (IL-6) receptor inhibitors, may help control symptoms of Covid-19. Areas of controversy Better knowledge of mechanisms of drug activities is essential for repurposing. Chemotherapies induce ER stress and enhance mutation rates and chromosome alterations, leading to resistance that cannot always be related to mutations in the target gene. Metformin, thalidomide and cytokines (IFN, tumor necrosis factor (TNF), interleukin-2 (IL-2) and others) have pleiomorphic activities, some of which can enhance tumorigenesis. The small and fragile patient pools available for clinical trials can cloud the data on the usefulness of cotreatments. Growing points Better understanding of drug metabolism and mechanisms should aid in repurposing drugs for primary, adjuvant and adjunct treatments. Areas timely for developing research Optimizing drug combinations, reducing cytotoxicity of chemotherapeutics and controlling associated inflammation.

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Are topical beta-blockers really effective “in real life” for targeted therapy-induced paronychia

Cited by 18 publications

References 18 publications

Efficacy of topical beta-blockers in the management of EGFR-inhibitor induced paronychia and pyogenic granuloma-like lesions: case series and review of the literature

Efficacy of topical beta-blockers in the management of EGFR-inhibitor induced paronychia and pyogenic granuloma-like lesions: case series and review of the literature

The role of topical timolol in wound healing and the treatment of vascular lesions: A narrative review

Repurposing approved drugs for cancer therapy

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