Metastatic extramammary Paget’s disease treated with paclitaxel and trastuzumab combination chemotherapy

• Published in: Journal of dermatology Vol. 36; no. 8; pp. 457 - 461
• Main Authors: TAKAHAGI, Shunsuke, NODA, Hideki, KAMEGASHIRA, Akiko, MADOKORO, Naoki, HORI, Ikuko, SHINDO, Hajime, MIHARA, Shouji, HIDE, Michihiro
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2009
• Subjects: Aged; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antineoplastic Agents, Phytogenic - therapeutic use; Antineoplastic Combined Chemotherapy Protocols; Central Nervous System - pathology; central nervous system metastasis; Central Nervous System Neoplasms - drug therapy; Central Nervous System Neoplasms - secondary; extramammary Paget’s disease; Genital Neoplasms, Male - drug therapy; Genital Neoplasms, Male - pathology; Genital Neoplasms, Male - surgery; human epidermal growth factor receptor 2 (HER2); Humans; Male; paclitaxel; Paclitaxel - therapeutic use; Paget Disease, Extramammary - drug therapy; Paget Disease, Extramammary - secondary; Paget Disease, Extramammary - surgery; Skin - pathology; Skin Neoplasms - drug therapy; Skin Neoplasms - secondary; Trastuzumab
• ISSN: 0385-2407; 1346-8138
• DOI: 10.1111/j.1346-8138.2009.00676.x

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.