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Anti-EGFR Nail Toxicity — SCE Medical Oncology MCQ

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ModerateGI CancersAnti-EGFR Nail ToxicitySCE Medical Oncology

A 58-year-old woman with mCRC on anti-EGFR therapy develops periungual inflammation, painful paronychia and pyogenic granuloma-like lesions of the fingernails and toenails. What is this toxicity?

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Correct answer: C — Anti-EGFR nail toxicity (periungual inflammation, paronychia, pyogenic granuloma) — a class effect of EGFR inhibition affecting the nail bed; managed with topical antiseptics, silver nitrate for granulation tissue and dose modification if severe

Anti-EGFR nail toxicity is a common and distressing class-effect adverse event occurring in 10-20% of patients on cetuximab/panitumumab. It manifests as periungual inflammation, secondary bacterial infection (paronychia), and pyogenic granuloma-like overgrowth. Management: topical antiseptics (chlorhexidine), topical antibiotics (mupirocin), silver nitrate cauterisation of granulation tissue, avoiding tight footwear and nail trauma. Severe cases may require dose modification. Podiatric referral is often helpful.

Reference: ESMO 2024 Dermatological Toxicity; BNF Cetuximab/Panitumumab; Lacouture et al JCO 2010