Real‐World Efficacy of Chemotherapy in Patients With Advanced Unresectable Extramammary Paget Disease: A Retrospective Multicenter Study of 138 Japanese Patients

Article

作者: Okada, Etsuko ; Fujii, Kazuyasu ; Yamamoto, Yuki ; Fujisawa, Yasuhiro ; Nakamura, Yasuhiro ; Maekawa, Takeo ; Yamazaki, Naoya ; Miyashita, Azusa ; Yoshino, Koji ; Kato, Hiroshi ; Kajihara, Ikko ; Asai, Jun ; Fujimura, Taku ; Otsuka, Atsushi ; Morinaga, Jun ; Matsushita, Shigeto ; Fukushima, Satoshi ; Ishizuki, Shoichiro ; Kawashima, Shusuke ; Kiniwa, Yukiko

ABSTRACT:

Extramammary Paget disease (EMPD) is a rare skin cancer with an estimated incidence rate of 0.13 per 100 000 population/year in Caucasians and 0.28 in Asians. Although distant metastases have been reported in 10%–20% of EMPD cases, standardized systemic chemotherapy has not been established. Prospective clinical trials are essential to establish standard treatments for advanced EMPD. Therefore, this retrospective study examined a substantial number of patients with EMPD to assess the efficacy of systemic chemotherapy. This study included 164 patients with advanced EMPD who underwent treatment at 16 Japanese institutions. Treatment efficacy was evaluated in a cohort of 138 patients, after excluding 26 patients without lesions outside the radical irradiation field from the 164 patients. The efficacy of each treatment was evaluated by determining the objective response rate (ORR), progression‐free survival (PFS), and overall survival (OS) using Kaplan–Meier analysis. Multivariate analysis was performed to account for potential confounding factors, such as age, sex, and performance status. The patients received the following treatments: docetaxel hydrate (DOC) (65.9%); tegafur/gimeracil/oteracil potassium, DOC (S‐1/DOC) (9.8%); fluorouracil and cisplatin (FP) (15.9%); and other drugs (8.5%). DOC is the most commonly used in Japan. The ORRs in the DOC, S‐1/DOC, and FP groups were 51.6%, 78.6%, and 27.8%, respectively. Logistic regression analysis revealed that, compared with the DOC group, the odds ratio for the ORR of the S‐1/DOC group was 3.29 (95% CI: 1.49–7.25, p = 0.003). However, no significant differences in OS or PFS were observed between the treatment groups ( p = 0.122 and p = 0.422, respectively). This study provides valuable information on EMPD and may serve as a useful historical control for the future evaluation of new treatments for EMPD.

2026-02-01·Gan to kagaku ryoho. Cancer & chemotherapy

[A Case of MSI‒High Advanced or Recurrent Gastric Cancer Showed Complete Response to Pembrolizumab as Third‒Line Treatment].

Article

作者: Tomita, Naohiro ; Shinno, Naoki ; Okuda, Tadahiro ; Shimizu, Junzo ; Imamura, Hiroshi ; Suzuki, Yozo ; Hagihara, Kiyotaka ; Noma, Toshiki ; Matsushita, Katsunori ; Kawase, Tomono

A 52‒year‒old female with gastric cancer revealed by a medical examination. The patient was diagnosed with T4b(pancreas)N2M0, CY0P0, cStage ⅣA, and after 3 courses of docetaxel+oxaliplatin+S‒1(DOS)therapy as preoperative chemotherapy, laparoscopic distal gastrectomy with D2 lymph node dissection and Roux‒en‒Y reconstruction were performed. Pathological histological examination showed ypT3(SS)N2M1(CY+), Stage Ⅳ, HER2(-), and S‒1+oxaliplatin(SOX)therapy was initiated as first‒line treatment. Tumor markers elevated and CT scan showed ascites after 5 courses and the treatment was consequently changed to paclitaxel+ramucirumab(PTX+Ram)therapy as second‒line treatment. CT scan showed para‒aortic lymph node enlarged and increased ascites after 2 courses, MSI‒High was identified at the same time and the treatment was consequently changed to pembrolizumab(Pem)monotherapy(200 mg/body, q21 days)as third‒line treatment. CT scan showed partial response(PR)after 3 courses, and subsequently resulted in a complete response(CR). After 36 courses of Pem monotherapy, the chemotherapy was terminated at the patient's request. Four years after the initial onset, the patient is currently alive without recurrence. No serious adverse events have occurred since the start of Pem monotherapy.

2026-02-01·Gan to kagaku ryoho. Cancer & chemotherapy

[Long‒Term Complete Response after Salvage Radiotherapy with Nivolumab Following Mediastinoscopic Esophagectomy in a High‒Risk Elderly Patient with Advanced Esophageal Cancer].

Article

作者: Matsumoto, Yoshihisa ; Otsuji, Eigo ; Matsuo, Hisataka ; Shiozaki, Atsushi ; Kuriu, Yoshiaki ; Ikoma, Hisashi ; Ito, Shun ; Takeda, Ryo ; Komatsu, Shuhei ; Fujita, Yuji ; Okamoto, Kazuma ; Ogawa, Soichiro ; Konishi, Tomoki

Neoadjuvant chemotherapy followed by radical esophagectomy is the standard treatment for advanced esophageal cancer in Japanese treatment guideline. However, in elderly patients with dysphagia and impaired organ function, preoperative chemotherapy may worsen their condition. We report here a case of a 79‒year‒old malnourished man with advanced esophageal squamous cell carcinoma and EGJ adenocarcinoma presenting with severe dysphagia. Given his age, frailty, and high‒risk of systemic decline, initial mediastinoscopic esophagectomy was selected over neoadjuvant therapy. Pathology showed a positive radial margin and PD‒L1 expression, prompting postoperative local salvage radiotherapy(40 Gy/20 fr)with nivolumab(480 mg/4 weeks). After 4 cycles, nivolumab was discontinued due to immune‒related pneumonitis, and S‒1 chemotherapy was initiated. Nearly 2 years postoperatively, the patient remains recurrence‒free. This case demonstrates the feasibility of a personalized, minimally invasive treatment strategy with tailored adjuvant therapy in high‒risk elderly patients.

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