Chinese botanical drugs for mitigating epidermal growth factor receptor-targeted therapy-associated cutaneous toxicity: immune mechanisms and translational pathways.

Background: Therapies targeting the epidermal growth factor receptor (EGFR) cause a spectrum of cutaneous toxicities that can compromise quality of life, treatment adherence, and cancer-treatment continuity. Persistent and phenotype-specific toxicities create a need for evidence-based adjunctive interventions. Purpose: Our aim was to appraise product-specific clinical and mechanistic evidence for Chinese botanical drugs in EGFR-targeted therapy-associated cutaneous toxicity and to define priorities for translational development. Methods: We conducted a structured narrative search of PubMed, Web of Science Core Collection, and Scopus from inception to 7 May 2026. Evidence was classified by the highest supporting design, from controlled human studies to indirect non-EGFR or computational evidence. We appraised directness, internal validity, product characterisation, outcome measurement, precision, and reporting completeness. Results and Discussion: Direct human evidence for defined Chinese botanical drugs remains insufficient to establish clinical efficacy. Available studies are limited by small samples, heterogeneous products, variable background care, and incomplete reporting. EGFR-specific experimental studies provide low-certainty support for barrier injury, inflammatory amplification, and phenotype-relevant mechanisms. Evidence from non-EGFR models, isolated metabolites, and network analysis remains hypothesis-generating. Conclusion: Defined Chinese botanical drugs should be evaluated only as adjuncts to standard supportive care. Progress will require standardised products, phenotype-stratified trials, prespecified patient-relevant and mechanistic outcomes, and complete reporting of safety and anticancer-treatment continuity.