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Clinical Trial
. 2016 Jul;142(1):139-143.
doi: 10.1016/j.ygyno.2016.04.028. Epub 2016 May 5.

A pilot study of topical imiquimod therapy for the treatment of recurrent extramammary Paget's disease

Renee A Cowan  1 , Destin R Black  1 , Lien N Hoang  2 , Kay J Park  2 , Robert A Soslow  3 , Floor J Backes  4 , Ginger J Gardner  5 , Nadeem R Abu-Rustum  5 , Mario M Leitao Jr  5 , Eric L Eisenhauer  4 , Dennis S Chi  6
Affiliations
Clinical Trial

A pilot study of topical imiquimod therapy for the treatment of recurrent extramammary Paget's disease

Renee A Cowan et al. Gynecol Oncol. 2016 Jul.

Abstract

Objective: The objective of this prospective pilot study was to assess the clinical and histologic effects of topical imiquimod therapy on recurrent extramammary Paget's disease of the vulva.

Methods: Patients with biopsy-proven recurrent extramammary Paget's disease presenting to the gynecology outpatient services at two participating institutions were recruited for conservative treatment with 5% imiquimod cream from 2007 to 2011. The topical cream was to be applied 3 times per week for 12weeks. Punch biopsy and photography were performed at baseline and at the 12-week time point.

Results: Eight patients from two institutions were enrolled. Complete clinical and histologic response was achieved in 6 (75%) patients by the 12-week follow-up appointment. Of the two remaining patients, one had a complete clinical response but no significant histologic response; the other patient was removed from the study protocol secondary to intolerable local irritation. Two patients continue to have no evidence of disease after a median follow-up of 35months. Five are alive with disease. No patients progressed to invasive cancer while receiving therapy.

Conclusion: Topical 5% imiquimod cream is a safe and feasible option for women suffering from recurrent extramammary Paget's disease of the vulva, and should be considered as a viable alternative to surgical management. Given the rare nature of this disease, additional multi-institutional prospective studies should be conducted to explore the efficacy of this treatment regime.

Keywords: Extramammary Paget's disease; Imiquimod; Vulvar cancer.

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Figures

Figure 1
Figure 1
Case 1 baseline photo on the left, post-treatment on the right
Figure 2
Figure 2
Case 2 baseline photo on the left, post-treatment on the right (photo and H&E slide)
Figure 3
Figure 3
Case 6 baseline photo on the left, post-treatment on the right
See this image and copyright information in PMC

References

    1. Lam C, Funaro D. Extramammary Paget's disease: summary of current knowledge. Dermatol Clin. 2010;28:807–26. - PubMed
    1. Fanning J, Lambert HC, Hale TM, Morris PC, Schuerch C. Paget's disease of the vulva: prevalence of associated vulvar adenocarcinoma, invasive Paget's disease, and recurrence after surgical excision. Am J Obstet Gynecol. 1999;180:24–7. - PubMed
    1. Parker LP, Parker JR, Bodurka-Bevers D, Deavers M, Bevers MW, Shen-Gunther J, et al. Paget's disease of the vulva: pathology, pattern of involvement, and prognosis. Gynecol Oncol. 2000;77:183–9. - PubMed
    1. Black D, Tornos C, Soslow RA, Awtry CS, Barakat RR, Chi DS. The outcomes of patients with positive margins after excision for intraepithelial Paget's disease of the vulva. Gynecol Oncol. 2007;104:547–50. - PubMed
    1. McFadden K, Sharp L, Cruickshank M. The prospective management of women with newly diagnosed vulval intraepithelial neoplasia: clinical outcome and quality of life. J Obstet Gynaecol. 2009;29:749–53. - PubMed

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