Efficacy of low‐dose 5‐fluorouracil/cisplatin therapy for invasive extramammary Paget's disease

Katô, Hiroshi; Watanabe, Shōichi; Kariya, Kiyonori; Nakamura, Minoru; Morita, Akimichi

doi:10.1111/1346-8138.14247

Cited by 22 publications

(25 citation statements)

References 19 publications

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“…Radiation therapy is considered a treatment strategy in patients who were poor surgical candidates [31]. Other non-surgical treatments such as 5-fluorouracil or topical imiquimod have been used either in non-invasive or recurrent PPD [18,32,33]. photodynamic therapy with topically applied 5aminolevulinic acid has been reported to treat non-invasive PPD and achieved complete cure without recurrence [34].…”

Section: Discussionmentioning

confidence: 99%

Perianal Paget’s disease: a clinicopathological and immunohistochemical study of 13 cases

et al. 2020

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Background: Perianal Paget's disease (PPD) is rare and mostly described in clinical literature as case reports or small series. Methods: We investigated the clinicopathologic and immunohistochemical features of PPD in a total of 13 cases retrieved from multiple academic institutions. Results: The median age at diagnosis was 75 (range 50-86) years. Males were predominant with a male to female ratio of 2.25:1. Four (30.8%) cases were classified as primary PPD due to lack of synchronous or metachronous underlying malignancies, while nine (69.2%) were classified as secondary PPD with concurrent invasive adenocarcinoma (n = 8) or tubular adenoma with high-grade dysplasia (n = 1). Immunohistochemically, there is no differential expression of CK7 or CK20 in Paget's cells between primary and secondary PPD; however, GCDFP-15 was only positive in primary PPD (3/3 vs. 0/6, P = 0.012), while CDX2 was only positive in secondary PPD (0/3 vs. 7/7, P = 0.008), suggesting different cell origin. All patients received local surgical resection with or without adjuvant therapy. After a median followup of 47 months, one patient with secondary PPD (7.7%) died of disease progression from underlying adenocarcinoma. Conclusions: PPD occurs in elderly patients with male predominance and is frequently associated with underlying malignancies. Differential expression of CDX2 and GCDFP-15 may help distinguishing primary vs. secondary PPD, which is important for management as the presence of an underlying malignancy impacts clinical course and prognosis. Surgical excision remains the major treatment strategy for PPD. Long-term follow-up is required to monitor the disease recurrence and metastasis.

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Section: Discussionmentioning

confidence: 99%

Perianal Paget’s disease: a clinicopathological and immunohistochemical study of 13 cases

et al. 2020

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“…[16][17][18][19] As such, topical 5-FU has been most commonly used in combination treatment with systemic chemotherapy in advanced cases of extramammary PD or in combination with other topical therapies in cases of resistant disease. [20][21][22] It can also be useful prior to surgery to delineate the extent of cutaneous involvement due to its inflammatory effects. 18,19 Topical 5% imiquimod cream was first reported as a treatment for PDV in 2002.…”

Section: Discussionmentioning

confidence: 99%

A Case of Chronic and Relapsing Paget Disease of the Vulva

Bouceiro-Mendes

Mendonça-Sanches

Soares‐de‐Almeida

et al. 2019

Rev Bras Ginecol Obstet

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Extramammary Paget disease is a rare neoplastic condition that more commonly affects postmenopausal Caucasian women. Although the vulvar area is the most frequently affected location, it corresponds solely to 1 to 2% of all vulvar malignancies. A 72-year-old female patient was observed in our outpatient clinic with a 2-year history of an erythematous and pruritic plaque on the vulva. Histopathology and immunohistochemistry studies were compatible with extramammary Paget disease of the vulva. Associated neoplastic conditions were excluded. Due to multiple relapses, the patient was submitted to three surgical interventions, including a total vulvectomy, and to external radiotherapy. The present case illustrates the chronic and recurrent nature of extramammary Paget disease despite aggressive procedures as well as the challenge in obtaining tumor-free resection margins.

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“…Most extramammary Paget’s lesions are detected in the early stage and thus have a favorable prognosis. For advanced cases, however, few effective treatments exist, 5 and the prognosis for patients with multiple metastases is poor 6,7 . Biomarkers that reflect early lymph node (LN) metastasis are therefore critical.…”

Section: Introductionmentioning

confidence: 99%

“…For advanced cases, however, few effective treatments exist, 5 and the prognosis for patients with multiple metastases is poor. 6,7 Biomarkers that reflect early lymph node (LN) metastasis are therefore critical. Serum carcinoembryonic antigen (CEA) may be a useful biomarker for extramammary Paget's disease.…”

Section: Introductionmentioning

confidence: 99%

Combined serum carcinoembryonic antigen and cytokeratin 19 fragment levels provide a sensitive biomarker for lymph node metastasis in extramammary Paget’s disease

Katô

Nakamura

Watanabe

et al. 2020

The Journal of Dermatology

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Most cases of extramammary Paget's disease are diagnosed at an early stage. For advanced cases, few effective treatments are available and the prognosis is poor. Therefore, developing sensitive biomarkers for metastatic cases is a critical challenge. Carcinoembryonic antigen (CEA) and cytokeratin 19 fragment (CYFRA) are two potentially useful biomarkers. In the present retrospective large-scale study, we identified other potential biomarkers of lymph node metastasis. Patients with extramammary Paget's disease who visited our dermatology clinic between April 2004 and March 2019 (n = 138; mean age, 73.4 years; 85 men and 53 women) were enrolled in the study. The patients were divided into three groups according to the presence of regional lymph node metastasis and distant metastasis to evaluate the relationship between metastasis and various tumor markers: serum CEA, carbohydrate antigen (CA)19-9, CA125, CA15-3 and CYFRA. For distal metastasis, each biomarker had high sensitivity and specificity. The sensitivities and specificities for regional lymph node metastasis were as follows: CEA, 50.0% and 88.6%; CA19-9, 50% and 89.5%; CA125, 0% and 98.2%; CA15-3, 0% and 96.0%; and CYFRA, 66.7% and 95.0%, respectively. We also analyzed biomarker combinations. The sensitivity and specificity of the combination of all five biomarkers (CEA, CA19-9, CA125, CA15-3 and CYFRA) were 83.3% and 70.9%, respectively. The sensitivity of the combination of just CEA and CYFRA was also 83.3%. Screening for combinations of these biomarkers will facilitate the detection of early lymph node metastasis in patients with extramammary Paget's disease.

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Efficacy of low‐dose 5‐fluorouracil/cisplatin therapy for invasive extramammary Paget's disease

Cited by 22 publications

References 19 publications

Perianal Paget’s disease: a clinicopathological and immunohistochemical study of 13 cases

Perianal Paget’s disease: a clinicopathological and immunohistochemical study of 13 cases

A Case of Chronic and Relapsing Paget Disease of the Vulva

Combined serum carcinoembryonic antigen and cytokeratin 19 fragment levels provide a sensitive biomarker for lymph node metastasis in extramammary Paget’s disease

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