Clinical Trials Of Different Topical Drugs For The Treatment Of EGFRIs-associated Paronychia

This master's thesis includes two parts:literature review and clinical research.The first part:literature review.The first review summarizes some progresses in targeted therapy in non-small cell lung cancer,and reviews the epidemiology of lung cancer,common driver mutations of NSCLC,targeted drugs,and some rare mutated genes.The second review summarizes the progress of diagnosis and treatment of the epidermal growth factor receptor inhibitors(EGFRIs)associated paronychia,and discuss the common dermatological adverse reactions of EGFRIs,the anatomy of nails,the pathogenesis of EGFRIs-associated paronychia,the incidence,classification,clinical manifestations,Western medical treatment methods,routine nursing methods.Meanwhile,the understanding of traditional Chinese medicine on paronychia,the etiology and pathogenesis of traditional Chinese medicine,and therapies are summarized.The second part:clinical research.OBJECTIVE:To compare the effects and safety of four external agents,including clobetasol propionate ointment,antibiotic fusidic acid cream and minocycline ointment,and traditional Chinese medicine Zhiyang Pingfu decoction in the treatment of epidermal growth factor inhibitors-related paronychia.And to find effective methods to treat paronychia which is caused by targeted drugs,in order to reduce the suffering of patients and improve the quality of patients' life.METHODS:It was a prospective,randomized,open,controlled clinical trial and included 53 patients with malignant tumors who were receiving epidermal growth factor receptor inhibitors and suffering from paronychia.Using a simple randomization method,53 patients were randomly assigned to clobetasol propionate group,fusidic acid group,minocycline group,and traditional Chinese medicine Zhiyang Pingfu decoction group according to a computer random number table.Clobetasol propionate ointment,fusidic acid cream and and traditional Chinese medicine Zhiyang Pingfu decoction were applied twice a day for external use,while minocycline was applied once a day for external use.14 days is a course of treatment,on the 7th and 14th days,the patients were followed up to observe the classification of paronychia after treatment,the improvement of symptoms,the time of symptom improvement,blood routine,and liver and kidney functions.RESULTS:(1)The four drugs had different degrees of improvement in EGFRIs-associated paronychia.After treatment,the classification of paronychia in the minocycline group and the Zhiyang Pingfu decoction group was superior to clobetasol propionate group and fusidic acid group(P<0.05),but there was no significant difference between clobetasol propionate group and fusidic acid group,and minocycline group and Zhiyang Pingfu decoction group.The effective rates of the clobetasol propionate group,fusidic acid group,minocycline group,and traditional Chinese medicine Zhiyang Pingfu decoction group were 85 7%,50%,100%,and 91.6%respectively.The curative effect of minocycline group and Zhiyang Pingfu decoction group was better than fusidic acid group(P<0.05).(2)The clobetasone propionate group's shortest time of symptoms improvement was 5 days and the longest was 14 days,with an average of 9.67±2.64 days.The fusidic acid group's shortest time of symptoms improvement was 1 day and the longest was 14 days,with an average of 8.86±4.67 days.The time of improvement in the Zhiyang Pingfu decoction was as short as 1 day and as long as 7 days,with an average of 3.45± 1.81 days.The minocycline group's shortest time of symptoms improvement was 1 day and the longest was 12 days,with an average of 4.92±2.69 days.After statistical analysis,the time for improving the symptoms of Chinese herbal medicine Zhiyang Pingfu decoction group and minocycline group was shorter than clobetasol propionate group,and the symptom improvement time of Chinese medicine group was also better than fusidic acid group.(3)The improvement of deck thinning,embrittlement,cracking,and delamination in the clobetasol propionate and fusidic acid group was better than minocycline group and Zhiyang Pingfu decoction group,while the minocycline group and Zhiyang Pingfu decoction group was superior to clobetasol propionate group and fusidic acid group in improving analgesia,pain,rift,and suppurative granuloma of the aperiod.CONCLUSION:Four kinds of external medicines have their own advantages and disadvantages in the treatment of EGFRIs-associated paronychia,which can all relieve the symptoms.Different medicines can be selected according to the symptoms and severity of the patients.