The study concluded that further clinical research is needed to explore other immune escape pathways in EMPD.14 A study investigates the Warburg effect in EMPD, finding that elevated glycolytic enzymes like LDHA are associated with increased immunosuppressive cells and cytokines.15 These studies suggest that the tumor microenvironment of EMPD leads to immunotherapy resistance, suggesting that EMPD patients have a poor response to immunotherapy, which is consistent with our observation. This evidence concerns the gene LDHA and extramammary Paget disease.