Oguchi Shinji, Kaneko Miwako, Uhara Hisashi, Saida Toshiaki
Department of Dermatology, Shinshu University School of Medicine, Matsumoto, Japan.
J Dermatol. 2002 Jan;29(1):33-7. doi: 10.1111/j.1346-8138.2002.tb00162.x.
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.
该患者为一名54岁的日本男性，阴囊出现糜烂性病变已有7个月。皮肤活检确诊为乳房外佩吉特病，CT扫描显示髂动脉和主动脉沿线淋巴结有多处转移。患者接受了丝裂霉素C、表柔比星、长春新碱、顺铂和5-氟尿嘧啶的联合化疗。经过两个疗程的治疗，阴囊上的原发性病变有所消退，然而，淋巴结转移并无反应。低剂量顺铂和5-氟尿嘧啶的持续给药方案对转移灶也无效。因此，开始每四周以60mg/m²的剂量给予多西他赛。两个疗程后，淋巴结转移灶相较于治疗前大小缩小了75%，疗效判定为部分缓解。主要毒性反应为中性粒细胞减少、脱发、凹陷性水肿和面部红斑，但这些均可耐受。该方案进行五个疗程后，接着每周给予25mg/m²多西他赛，共四个疗程。部分缓解持续超过12个月，患者能够正常生活。多西他赛可能是晚期乳房外佩吉特病患者的有效药物。
