Docetaxel Induced Durable Response in Advanced Extramammary Paget's Disease: A Case Report

Abstract

The patient was a 54-year-old Japanese man with a seven-month history of an eroded lesion on the scrotum. Skin biopsy confirmed the diagnosis of extramammary Paget's disease, and a CT scan revealed multiple metastases to the lymph nodes along the iliac artery and aorta. The patient underwent combination chemotherapy with mitomycin C, epirubicin, vincristine, cisplatin, and 5-fluorouracil. After two courses of the regimen, the primary lesions on the scrotum regressed, however, the lymph node metastases did not respond. A regimen of continuous administration of low-dose cisplatin and 5-fluorouracil was not effective for the metastases either. Hence, administration of docetaxel at a dose of 60 mg/m2/every four weeks was started. After two courses, the lymph node metastases decreased by 75% compared to the pre-treatment size, and the effect was judged a partial response. The major toxicities were neutropenia, alopecia, pitting edema, and facial erythema, but these were tolerable. Five courses of this regimen were followed by four courses of weekly administration of 25 mg/m2 docetaxel. The partial response persisted for more than 12 months and the patient was able to enjoy daily life. Docetaxel may be an effective drug for patients with advanced extramammary Paget's disease.

Extramammary Paget Disease of External Genitalia: Surgical Excision and Follow-up Experiences With 19 Patients

“…Lee et al [20] reported a high success rate of Mohs surgery for nonmetastatic EMPD in Korea. There are some studies on chemotherapy in the management of EMPD [21-25], but the efficacy has not been clarified. We plan to further investigate and report on the multimodality treatment of EMPD in a future publication.…”

Response to 5-Fluorouracil in Metastatic Extramammary Paget Disease of the Scrotum Presenting as Pancytopenia and Back Pain

“…Radiation therapy is an acceptable alternative in situations in which surgery might be functionally destructive, or when the disease has recurred after excision 10. No effective chemotherapy regimens for locally advanced or metastatic extramammary Paget disease have been established, and combinations of agents mentioned in case reports include 5 fu plus mitomycin C 11, carboplatin plus 5 fu and leucovorin 12, low-dose 5 fu plus cisplatin 13,14, single-agent docetaxel 15, and mitomycin C plus epirubicin, vincristine, cisplatin, and 5 fu 16. response rates cannot be estimated from these studies, but local control and the occasional complete response have been documented.…”

Extramammärer Morbus Paget – Klinik, Histogenese, Therapiemöglichkeiten

“…Darüber hinaus wurde die Radiotherapie bei postoperativen Rezidiven erfolgreich eingesetzt [15,58,59]. Einzelne Autoren empfehlen die Radiatio auch als adjuvante Therapie nach primärer Exzision des Tumors, wenn von einem hohen Rezidivrisiko ausgegangen werden muss [15,59] [66,67]. Interessanterweise kam es unter einer Monotherapie mit Docetaxel zu einer Remission vorhandener Lymphknotenmetastasen, nachdem diese zuvor auf Polychemotherapieschemata nicht angesprochen hatten [66].…”

“…Einzelne Autoren empfehlen die Radiatio auch als adjuvante Therapie nach primärer Exzision des Tumors, wenn von einem hohen Rezidivrisiko ausgegangen werden muss [15,59] [66,67]. Interessanterweise kam es unter einer Monotherapie mit Docetaxel zu einer Remission vorhandener Lymphknotenmetastasen, nachdem diese zuvor auf Polychemotherapieschemata nicht angesprochen hatten [66]. Die insgesamt erheblichen Nebenwirkungen dieser Therapieschemata sollten berücksichtigt werden [68].…”