Yoshino Koji, Fujisawa Yasuhiro, Kiyohara Yoshio, Kadono Takafumi, Murata Yozo, Uhara Hisashi, Hatta Naohito, Uchi Hiroshi, Matsushita Shigeto, Takenouchi Tatsuya, Hayashi Toshihiko, Ohara Kuniaki
Department of Dermatology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan.
Department of Dermatology, University of Tsukuba, Tsukuba, Japan.
J Dermatol. 2016 Jun;43(6):633-7. doi: 10.1111/1346-8138.13200. Epub 2015 Nov 25.
In invasive extramammary Paget's disease (EMPD), distant metastases may develop and the condition may become fatal; however, no standardized treatment has been established. Although based on only a few cases, several chemotherapy regimens were reported to be promising. We conducted a multicenter, retrospective study to evaluate the efficacy of docetaxel for metastatic EMPD. We retrospectively collected data on 18 metastatic EMPD patients treated using docetaxel from 1998 to 2012 in 12 institutes in Japan. The following clinical data were collected: tumor response, time to progression, overall survival and adverse effects. Of those, three patients treated combined with S-1, one patient treated with weekly schedule and one patient treated combined with radiotherapy were excluded from the further analysis. All 13 patients received monthly docetaxel as the first-line treatment. The average number of treatment cycles was 9.1. Among the 12 patients with a confirmed response, seven (58%) showed a partial response, three (25%) stable disease and two (17%) progressive disease. The disease control rate (partial response + stable disease) was as high as 83%. The time to progression and median overall survival were 7.1 and 16.6 months, respectively. The 1-year overall survival rate determined by the Kaplan-Meier method was 75.0%. All adverse effects were manageable and no treatment-related deaths were observed. The high disease control rate and overall survival shown by this study suggest that first-line use of docetaxel may be a promising treatment for metastatic EMPD. A prospective clinical trial is required to confirm our results.
在侵袭性乳腺外佩吉特病(EMPD)中,可能会发生远处转移,病情可能会致命;然而,尚未确立标准化治疗方案。尽管仅基于少数病例,但据报道几种化疗方案颇具前景。我们进行了一项多中心回顾性研究,以评估多西他赛对转移性EMPD的疗效。我们回顾性收集了1998年至2012年期间日本12家机构使用多西他赛治疗的18例转移性EMPD患者的数据。收集了以下临床数据:肿瘤反应、疾病进展时间、总生存期和不良反应。其中,3例联合S-1治疗的患者、1例采用每周给药方案治疗的患者和1例联合放疗治疗的患者被排除在进一步分析之外。所有13例患者均接受每月一次的多西他赛作为一线治疗。平均治疗周期数为9.1个。在12例有明确反应的患者中,7例(58%)显示部分缓解,3例(25%)病情稳定,2例(17%)疾病进展。疾病控制率(部分缓解+病情稳定)高达83%。疾病进展时间和中位总生存期分别为7.1个月和16.6个月。采用Kaplan-Meier法确定的1年总生存率为75.0%。所有不良反应均可控制,未观察到与治疗相关的死亡。本研究显示的高疾病控制率和总生存期表明,一线使用多西他赛可能是转移性EMPD的一种有前景的治疗方法。需要进行前瞻性临床试验来证实我们的结果。