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Purpose of Review Extramammary Paget disease (EMPD) is a rare entity which is more frequently localized at the vulva, though it only accounts for 1–2% of vulvar neoplasms. It is a primary cutaneous adenocarcinoma whose cell of origin is still a matter of controversy: it can either arise from apocrine/eccrine glands or from stem cells. The diagnosis demands a biopsy and entails a histopathological analysis by which cells show similar characteristics as breast Paget disease. Recent Findings Treatment approach can entail surgery, radiotherapy, photodynamic therapy, systemic chemotherapy, and topical chemotherapy. For metastatic disease, many different chemotherapy regimens have been explored and even targeted therapy can play an important role in this disease. Since almost 30–40% of patients overexpress HER-2, trastuzumab and anti-HER-2 therapies can be employed in this setting. Summary Due to its low incidence, there is almost no specific evidence on therapeutic interventions for this disease. Thus, there is a neat unmet need for molecular characterization of EMPD and diagnostic tools that allow clinicians to guide treatment both in the early and in the advanced disease settings. In this review, we aim to summarize available evidence about diagnosis and treatment of EMPD, both localized and metastatic, and to provide a comprehensive analysis that may help clinicians for therapeutic decisions.

Introduction: Androgenic deprivation therapies have been linked to the development of metabolic syndrome (MS) and cardiovascular diseases, which may lead to a poorer survival in patients with metastatic Castration-Resistant Prostate Cancer (mCRPC). We aimed to analyze whether some cardiovascular or neurological disorders, together with other medical and urological complications, may have an effect on survival outcomes, at baseline and during treatment from patients treated with androgen pathway inhibitors (API). Material and Methods: A retrospective study of a consecutive series of patients diagnosed with mCRPC between 2010 and 2018 treated with API in the first line setting in a single center. Results: Seventy-three patients met the inclusion criteria. Baseline prognostic factors associated with worse survival were diabetes mellitus (DM) with insulin needs compared to patients without DM [hazard ratio (HR) = 0.19, p = 0.025], hypertension (HTN) (HR = 0.46, p = 0.035), and a history of stroke (HR = 0.16, p < 0.001). However, previous history of hypercholesterolemia, arrythmias, and cognitive disorders did not result in a significant worsening on survival. During treatment, patients who developed de novo HTN had the best progression free survival (PFS) (HR = 0.38, p = 0.048) and overall survival (OS) (HR 0.08, p = 0.012) compared with patients with previous HTN. Other factors related to worse outcomes included the presence of heart failure (HR = 0.31, p = 0.001), the requirement for major opioids for pain relief (HR = 0.33, p = 0.023), and the presence of bilateral ureterohydronephrosis (HR = 0.12, p = 0.008). Conclusions: Some comorbidities may be strongly involved in patient outcomes when receiving API for mCRPC. In this sense, collaborative networking between specialists and caregivers treating prostate cancer (PC) patients should be recommended, focusing on MS features, cardiovascular and neurological disorders in order to anticipate medical and surgical complications.

rate (ORR), TTP, and OS: RAS (KRAS/NRAS) mutational status, primary tumour location and metastases site, efficacy of first-line treatment, sex, age, body mass index, lactate dehydrogenase (LDH), alkaline phosphatase, CEA, lymphocytes and haemoglobin level at the time of beginning second line treatment. Median follow-up was 35 months. Results: In whole group median TTP was 5.1 months and OS -12.9. Response rates: CR -1%, PR -18%, NC -40%, PD -40%. For patients who achieved ORR (CR or PR) median TTP and OS was 7.8 and 19.3 months while for patients with PD -2.8 and 9.9. Hepatic location of metastases was associated with the highest rate of ORR, while peritoneal with the lowest: 46% and 0% (p ¼ 0.041) respectively. Median TTP for patients who gained CR, PR or NC (DCR -disease control) while first-line treatment was 6.7 compared with 3.3 months for patients with PD (p < 0,0001). TTP under/equal 6 months and PD during first-line treatment were associated with shorter OS: 12.9 vs 15.3 months (p ¼ 0.049) and 9.9 vs 14.2 months (p ¼ 0.007). Age over 70 and BMI !25 were good prognostic factors with OS 19.6 months vs 10.4 (p ¼ 0.01) and 18.4 months vs 9.1 (p ¼ 0.039) respectively. There was no difference between patients in terms of KRAS and NRAS mutational status. For wild type and mutant tumours it was 6.6 months vs 6.1 (p ¼ 0.098) and 17.9 vs 12.9 (p ¼ 0.183) respectively in TTP and OS. Right-side primary tumours were associated with worse DCR, TTP and OS compared to left-side primary; 45%, 2.3 months and 11.2 months vs 61%, 4.9 months and 12.8 months, but the differences were not statistically significant. Other factors did not occur relevant. Sixteen patients (20%) discontinued treatment due to adverse events. There were no toxic deaths. Conclusion: Positive prognostic impact on second-line treatment with bevacizumab and FOLFOX4 in mCRC have: first-line treatment response, hepatic site of metastases, age over 70 and BMI !25. Worse prognosis was observed in group of patients with peritoneal metastases and poor response for first-line chemotherapy. RAS mutational status seemed to not influence prognosis in the analysed cohort. Location of the primary tumour in the right side of the colon was not proven to be a negative prognostic factor. P À 231 Clinical significance of microsatellite instability in Introduction: Colorectal cancer (CRC) with microsatellite instability (MSI) are known to have better prognosis compared to those with microsatellite stable (MSS). Recent studies reported that there are biological differences according to tumor location in CRC. In this study, we aimed to identify the clinical significance of MSI in patients with right-sided CRC. Methods: Between October 2004 and December 2016, medical records from a total of 1,009 patients with CRC were retrospectively reviewed. Patients with MSI testing were included in the analysis. We assessed the long-term outcomes of MSI according to the tumor location using the Kaplan-Meier curves and Cox regression models. Results: The median follow-up duration was 25 ...