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Extramammary Paget's disease medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Chemotherapy with either 5-fluorouracil, imiquimod cream, or the combination of paclitaxel and trastuzumab may be helpful in the treatment of extramammary Paget’s disease.

Medical Therapy

The following medical therapies have been studied for the treatment of extramammary Paget’s disease:[1][2][3][4]

Medication Mechanism of action Dosage
Imiquimod
  • These agents modulate key factors of the immune system
  • Imiquimod is a immune response modifier with an unknown mechanism of action
  • Imiquimod 5% cream is applied 3 times weekly for 16 weeks.
Fluorouracil
  • These agents inhibit cell growth and proliferation
  • Fluorouracil interferes with DNA synthesis by blocking methylation of deoxyuridylic acid via inhibition of thymidylate synthetase and, eventually, cell proliferation.
  • It is used topically
Paclitaxel
  • Paclitaxel’s mechanism of action involves interference with the normal breakdown of microtubules during cell division
Trastuzumab
  • Trastuzumab is a recombinant monoclonal antibody against human epidermal growth factor receptor 2 (HER2). It is effective when tumor cells overexpress HER2 protein.

References

  1. ↑ Takahagi S, Noda H, Kamegashira A, Madokoro N, Hori I, Shindo H; et al. (2009). “Metastatic extramammary Paget’s disease treated with paclitaxel and trastuzumab combination chemotherapy”. J Dermatol. 36 (8): 457–61. doi:10.1111/j.1346-8138.2009.00676.x. PMID 19691751.
  2. ↑ Sendagorta E, Herranz P, Feito M, Ramírez P, Floristán U, Feltes R; et al. (2010). “Successful treatment of three cases of primary extramammary Paget’s disease of the vulva with Imiquimod–proposal of a therapeutic schedule”. J Eur Acad Dermatol Venereol. 24 (4): 490–2. doi:10.1111/j.1468-3083.2009.03451.x. PMID 19840203.
  3. ↑ Marchitelli C, Peremateu MS, Sluga MC, Berasategui MT, Lopez DG, Wernicke A; et al. (2014). “Treatment of primary vulvar paget disease with 5% imiquimod cream”. J Low Genit Tract Dis. 18 (4): 347–50. doi:10.1097/LGT.0000000000000053. PMID 25259595.
  4. ↑ Beleznay KM, Levesque MA, Gill S (2009). “Response to 5-fluorouracil in metastatic extramammary Paget disease of the scrotum presenting as pancytopenia and back pain”. Curr Oncol. 16 (5): 81–3. PMC 2768510. PMID 19862365.


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