Systematic Review and Meta-Analysis: Is There a Benefit in Using Neoadjuvant Systemic Chemotherapy in Locally Advanced Penile Squamous Cell Carcinoma?

Neoadjuvant chemotherapy (NAC) is a recommended treatment in penile cancer patients with bulky inguinal lymphadenopathy or unresectable primary tumors although there is no evidence of its benefit from randomized trials.

We conducted a systematic search in Embase and MEDLINE for studies reporting on patients who received preoperative NAC for locally advanced PSCC. Objective response rate (ORR), pathologic complete response (pCR), grade ≥3 toxicity and overall mortality (OM) were evaluated in terms of NAC type, which was dichotomized as non-taxane-platinum (NTP) and taxane-platinum (TP) regimens.

Overall, 10 studies met the inclusion criteria enrolling a total of 182 patients; 66 (36.3%) and 116 (63.7%) were treated with NTP and TP regimens, respectively. The pooled results demonstrated ORR of 53% (95% CI: 42%-64%) pCR of 16%, grade ≥3 toxicity rate of 40% (95% CI: 19%-64%) and OM of 55% (95% CI: 40%-70%) in patients treated with NAC. Stratified sub-analysis revealed an ORR of 55% and 49%; a pCR of 9% and 20%; a toxicity rate of 26% and 49%; and an OM of 54% and 58% for NTP vs. TP regimens, respectively.

The pooled findings in this study suggest that approximately 50% of the patients with bulky regional lymph node metastases from penile cancer respond to platinum-based NAC and approximately 16% of patients achieve a pCR. Non-taxane based regimens appear to be better tolerated than taxane regimens based on reported grade ≥III adverse events (26% vs 49%). Ultimately, the robustness of these observations should be interpreted with an awareness of the inherent limitations of deriving data from a collection of small, heterogeneous series.

The Journal of urology. 2020 Jan 13 [Epub ahead of print]

Mounsif Azizi, Ahmet M Aydin, Ali Hajiran, Andrew Lai, Ambuj Kumar, Charles C Peyton, Suks Minhas, Guru P Sonpavde, Jad Chahoud, Lance C Pagliaro, Andrea Necchi, Philippe E Spiess

Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida., Department of Urology, University of Illinois at Chicago, Chicago, Illinois., Division of Evidence Based Medicine and Health Outcomes Research, University of South Florida, Tampa, Florida., Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK., Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts., Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota., Department of Urology and Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.

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