title: Metastatic extramammary Paget's disease treated with paclitaxel and trastuzumab combination chemotherapy.
abstract: In the treatment of metastatic breast cancer, trastuzumab, a recombinant monoclonal antibody against human epidermal growth factor receptor 2 (HER2), is effective when tumor cells overexpress HER2 protein. Although some cases of extramammary Paget's disease (EMPD) also express HER2 protein, no case of EMPD has been reported to be treated with trastuzumab. A 75-year-old man who suffered from EMPD of the scrotum and inguinal region underwent a local excision and lymph node dissection. Tumor cells invaded the dermis and lymph nodes. Although he was postoperatively treated with adjuvant chemotherapies, metastatic skin lesions appeared and spread over his left thigh, rapidly and widely. Tumor cells disseminated along lymph vessels in the dermis and overexpressed HER2 protein. We administered paclitaxel and trastuzumab according to a protocol for HER2-positive metastatic breast cancers. The skin metastasis dramatically decreased during the regimen and a histopathological examination showed that most of HER2-positive tumor cells diminished. Six months later, metastases were found in the central nervous system (CNS), but no other metastases were found in the skin, visceral organs or lymph nodes. Trastuzumab and paclitaxel-combination with the assessment of central nervous system lesions should be considered as an option for the treatment of HER2-positive EMPD.
authors.affiliation: Department of Dermatology, Division of Molecular Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Takahagi
authors.forename: Hideki
authors.initials: H
authors.lastname: Noda
authors.forename: Akiko
authors.initials: A
authors.lastname: Kamegashira
authors.forename: Naoki
authors.initials: N
authors.lastname: Madokoro
authors.forename: Ikuko
authors.initials: I
authors.lastname: Hori
authors.forename: Hajime
authors.initials: H
authors.lastname: Shindo
authors.forename: Shouji
authors.initials: S
authors.lastname: Mihara
authors.forename: Michihiro
authors.initials: M
authors.lastname: Hide
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols; D002490:Central Nervous System / Q000473:pathology; D016543:Central Nervous System Neoplasms / Q000188:drug therapy / Q000556:secondary; D005834:Genital Neoplasms, Male / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D017239:Paclitaxel / Q000627:therapeutic use*; D010145:Paget Disease, Extramammary / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D012867:Skin / Q000473:pathology; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000556:secondary; D000068878:Trastuzumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000972:Antineoplastic Agents, Phytogenic; D000068878:Trastuzumab; D017239:Paclitaxel