Management of Nail Toxicities From Fibroblast Growth Factor Receptor Inhibitors.

BACKGROUND

Alterations in fibroblast growth factor receptor (FGFR) signaling are present in many malignancies, including urothelial carcinoma, cholangiocarcinoma, and gastrointestinal cancers, and FGFR inhibitors (FGFRi) play an increasing role in the treatment of these malignancies. Nail toxicities, such as onycholysis, paronychia, and nail fragility are an important part of the adverse effect profile of FGFRi that remain underrecognized and poorly characterized.

METHODS

We conducted a systematic literature review using PubMed and Google through March 2025, including case reports, trials, and retrospective studies reporting FGFRi-related nail disorders. Search terms included individual FGFRi (e.g., erdafitinib, pemigatinib, futibatinib) and nail-related adverse events. Data on incidence, severity (CTCAE v5.0), onset, management, and treatment impact were extracted. Statistical analyses included the Wilcoxon and Chi-square tests.

RESULTS

Twenty-three studies with 1,561 patients were analyzed. Out of these, 540 patients experienced nail toxicity. Erdafitinib had the highest nail toxicity rate (43.3%) and derazantinib the lowest (5.3%). Grade 1–2 events were most common; Grade 3 events prompted dose reduction in three patients out of 540, though no treatment discontinuations were reported. Common management strategies included antiseptic soaks, topical steroids, oral antibiotics, and protective nail care practices.

DISCUSSION/

CONCLUSION

The incidence of FGFRi-associated nail toxicities varies by agent and can affect quality of life and treatment adherence. The pathogenesis remains unclear, and no predictive biomarkers exist. Further research into optimized management and preventative strategies is needed. Early recognition and proactive multidisciplinary management are essential to minimizing complications and maintaining oncologic treatment continuity. &nbsp.