Effects of imiquimod on vulvar Paget's disease: A systematic review of literature

• Complete response rates at 2, 4, and 6-month after imiquimod treatment were 9.8%, 31.1%, and 71.6%, respectively.
• Treatment frequency reduction due to adverse effects was 9.5% for imiquimod therapy for vulvar Paget's disease.
• Age, disease type (primary versus recurrence), and treatment frequency reduction were not associated with response rate to imiquimod therapy.

ObjectiveTo examine the effectiveness of topical imiquimod therapy for vulvar Paget's disease.MethodsA systematic literature search was conducted using three public search engines with entry keywords “Paget's disease” and “imiquimod”. Case reports describing imiquimod treatment for vulvar Paget's disease were examined for demographics, treatment patterns, and outcome (63 cases).ResultsMedian age was 68, and nearly a half of cases were recurrent disease (50.8%) with surgical resection being the most common prior treatment modality (62.5%). All cases used 5% imiquimod and the median treatment duration was 4 months. The most common initial treatment frequency was 3–4 times/week (68.3%) followed by 5–7 (17.4%) and 1–2 times/week (14.3%). Frequency-reduction due to adverse effects was seen in 9.5% with the initial 5–7 times/week regimen being associated with the highest reduction rate (1–2, 3–4, and 5–7 times/week: 0%, 2.3%, and 81.8%, p < 0.01). In 46 (73.0%) cases, a complete remission (CR) to imiquimod therapy was reported, with 2, 4, and 6-month cumulative CR rates being 9.8%, 31.1%, and 71.6%, respectively. With median follow-up duration of 12 months after the completion of imiquimod treatment, 2 (5.7%) of the 35 women who had a CR developed disease recurrence. Age, disease status (primary versus recurrent), and treatment frequency after dose reduction were not associated with CR rates (all, p > 0.05).ConclusionOur results suggested that imiquimod therapy may be an effective possible treatment option for vulvar Paget's disease, especially for women who have experienced recurrence after multiple surgical resections or who are with poor surgical candidates.