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LETTER TO THE EDITOR
Year : 2015  |  Volume : 52  |  Issue : 1  |  Page : 73-74
 

Response to taxane-based chemotherapy in metastatic eccrine porocarcinoma with extensive cutaneous involvement


1 Department of Radiation Oncology, JIPMER, Pondicherry, India
2 Department of Medical Oncology, JIPMER, Pondicherry, India
3 Department of Pathology, JIPMER, Pondicherry, India

Date of Web Publication3-Feb-2016

Correspondence Address:
D Joseph
Department of Radiation Oncology, JIPMER, Pondicherry
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175586

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How to cite this article:
Joseph D, Dubashi B, Basu D, Srinivasan S, Jain A. Response to taxane-based chemotherapy in metastatic eccrine porocarcinoma with extensive cutaneous involvement. Indian J Cancer 2015;52:73-4

How to cite this URL:
Joseph D, Dubashi B, Basu D, Srinivasan S, Jain A. Response to taxane-based chemotherapy in metastatic eccrine porocarcinoma with extensive cutaneous involvement. Indian J Cancer [serial online] 2015 [cited 2021 Aug 5];52:73-4. Available from: https://www.indianjcancer.com/text.asp?2015/52/1/73/175586


Sir,

Eccrine porocarcinoma (EP) is a malignant tumor related to the sweat gland duct. These tumors are characterized by high local recurrence rate following surgical resection and generally an aggressive clinical behavior.

We present the successful control of symptoms and a good response to palliative taxane-based chemotherapy in an extensive and inoperable case of EP. A 56-year-old male presented with extensive ulcero-nodular lesions over the anterior abdominal wall and the anterior lower chest with excruciating pain, bleeding, and discharge. Clinical examination revealed bilateral axillary lymph node enlargement of size 10 × 8 cm on the right side. Other clinical examinations were normal. Biopsy from the lesion showed malignant adnexal tumor consistent with EP [Figure 1] and [Figure 2]. Cytologic analysis of lymph node was positive for malignant cells.
Figure 1: Nests and islands of tumor cells arising from epidermis and extending into dermis (H and E, ×100)

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Figure 2: Higher magnification of tumor cells showing prominent nucleolus and high mitotic rate (H and E, ×400)

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The patient was started on palliative chemotherapy with multi-agent regimen consisting of doxorubicin, mitomycin, vincristine, and 5-fluorouracil (5-FU), administered every 4 weeks in rotation with cisplatin and bleomycin.[1] Chemotherapy was changed to single agent paclitaxel 175 mg/m 2 every 3 weeks, as he developed progressive disease after the initial regimen. Carboplatin was added from subsequent cycles as he had minimal response to paclitaxel [Figure 3]. He had a partial response to this regimen in the form of pain relief, decrease in the size and number of skin lesions, and reduction in the size of the axillary nodes to 2 × 2 cm. Patient tolerated the schedule well, but eventually developed neuropathic changes. Hence, he was switched on to single agent docetaxel 75 mg/m 2. The treatment was well tolerated and resulted in marked symptom control and clinical response. He succumbed to his illness after a follow-up of 14 months.
Figure 3: Extensive nodulo-ulcerative lesions over the anterior abdominal wall

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Various chemotherapeutic agents have been used in the management of metastatic EP with varying response. Swanson et al. reported a complete response of 3 months duration by using a 96-h infusion of 5-FU in a patient with multiple systemic metastasis.[2] Docetaxel was used with good symptomatic relief in a patient reported by Plunkett et al.[3] There is report of a patient with multiple cutaneous and lymph nodal recurrence treated with prophylactic lymphadenectomy, radiotherapy, and oral isotretinoin, subsequently substituted by tegafur without any evidence of distant metastases after a 5.6-year follow-up.[4] A complete remission lasting 2 years was reported in a patient treated with a four-drug regimen using adriamycin, cyclophosphamide, vincristine, and bleomycin.[5] There is a case report of successful use of melphalan and intra-arterial 5 FU combined with regional hyperthermia by Briscoe et al. Perilesional injection of interferon (INF)-alpha and interleukin (IL-2) has shown some benefits. Bree et al. described a case in which topical 5-FU application and intra-arterial chemotherapy with docetaxel resulted in a histologically confirmed complete response of multiple regional skin metastases for more than 2 years.

Only few case reports are available regarding the management of inoperable or metastatic EP. Available literature shows the use of a wide range of chemotherapeutic agents which showed varying response. Taxane-based regimen provides good response and quality of life.

 
 » References Top

1.
Piedbois P, Breau JL, Morere JF, Israel L. Sweat gland carcinoma with bone and visceral metastases: Prolonged complete remission lasting 16 months as a result of chemotherapy. Cancer 1987;60:170-2.  Back to cited text no. 1
[PUBMED]    
2.
Swanson DJ, Pazdur R, Sykes E. Metastatic sweat gland carcinoma: Response to 5-fluorouracil infusion. J Surg Oncol 1989;42:69-72.  Back to cited text no. 2
    
3.
Plunkett TA, Hanby AM, Miles DW, Rubens RD. Metastatic eccrine porocarcinoma: Response to docetaxel (Taxotere) chemotherapy. Ann Oncol 2001;12:411-4.  Back to cited text no. 3
    
4.
González-López MA, Vázquez-López F, Soler T, Gómez-Diéz S, Garcia YH, Manjón JA. Metastatic eccrine porocarcinoma: A 5.6-year follow-up study of a patient treated with a combined therapeutic protocol. Dermatol Surg 2003;29:1227-32.  Back to cited text no. 4
    
5.
Mezger J, Remberger K, Schalhorn A. Treatment of metastatic sweat gland carcinoma by a four drug combination chemotherapy: Response in two cases. Med Oncol Tumor Pharmacother 1986;3:29-34.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]

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