(UroToday.com) Penile cancer is rare with an incidence of <1 per 100,000 in Western industrialized nations. Metastatic penile squamous carcinoma is a very rare disease with poor outcomes (overall survival < 1 year) despite the use of platinum-based chemotherapy agents. There is limited real-world data on how these patients are managed in clinical practice and their outcomes. At the European Society for Medical Oncology Virtual Congress (ESMO) 2020 annual meeting, Dr. Wing Kin Liu and colleagues presented results of their institutional long-term experience with metastatic penile cancer, which is the largest review of such patients to date.
This study included a prospective database of over 1,200 patients referred to the supra-regional penile multi-disciplinary team at St. George’s Hospital London, with data collected from 2006 to 2020. Patients were treated at St. George’s Hospital or at other centers with oncology guidance from the St George’s multi-disciplinary team. Metastatic disease was defined as the presence of disease outside the pelvis or those in whom curative therapy for the metastasis was not possible and hence treated with palliative intent. The indication of treatment was to treat symptoms and prolong survival. Clinical benefit rate, median progression-free survival and median overall survival were retrospectively analyzed.
There were 101 patients with metastatic disease that were included, with a median age of 63 years of age (IQR 56-72), and 73% of patients ECOG 0/1. There were 59% of patients that received chemotherapy and 42% of patients received best supportive care. Furthermore, 32% of patients received adjuvant chemotherapy prior to metastatic recurrence of disease, 17% of patients received subsequent second-line systemic therapy, and 3% of patients received third-line systemic therapy. For first-line systemic-therapy (n=59), there was a 45.8% clinical benefit rate with 8.5% complete responses, 15.3% partial responses and 22.0% with stable disease. Patients receiving 2nd line subsequent therapy (n=17) had a 29.4% clinical benefit rate. Median progression-free survival for first- and second-line treatment was 3.2 (95% CI 2.1-5.2) and 2.2 (95% CI 0.9-4.3) months respectively:
The median overall survival for all patients was 6.2 months (95% CI 5.1-7.2). Median overall survival for first-line chemotherapy was 7.2 months (95% CI 5.9-8.5), for second-line chemotherapy was 4.5 months (95% CI 2.5-6.5), and for best supportive care patients was 2.0 months (95% CI 1.1-2.9). Among patients receiving chemotherapy, the most common grade 3/4 adverse event was neutropenia and renal failure (both 8.5%).
Dr. Liu concluded this presentation of longitudinal outcomes among patients with metastatic penile cancer with the following take home messages:
- There were better outcomes for first-line chemotherapy patients compared to best supportive care patients, supporting the use of chemotherapy in fit metastatic penile squamous cell carcinoma patients
- The number of best supportive care patients was likely underestimated as they are not always referred to the multi-disciplinary team due to poor performance status and rapidly progressive disease
- First-line platinum-based chemotherapy is associated with a notable response and disease control rates in metastatic penile cancer patients
- Agents with better response rates are urgently needed possibly in combination with platinum-based chemotherapy to improve outcomes
Presented by: Wing Kin Liu, PhD, St. George’s University Hospitals NHS Foundation Trust London, United Kingdom
Written by: Zachary Klaassen, MD, MSc – Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, Twitter: @zklaassen_md at the 2020 European Society for Medical Oncology Virtual Congress (#ESMO20), September 19th-September 21st, 2020.