BERKELEY, CA (UroToday.com) - The optimal treatment of locally advanced and regionally metastatic penile cancer remains a dilemma. Based upon existing therapeutic strategies, it is clear that single modalities rarely cure the disease. However, the optimal integration of therapies such as surgery, radiation, and chemotherapy remains elusive given the rarity of penile cancer and the resulting lack of prospective randomized clinical trials. In this report we broaden our previously described experience combining preoperative chemotherapy with surgery, including an additional 31 patients and 5 years of follow-up.
The cohort represents a heterogeneous group of patients with regionally advanced penile cancer, including those exhibiting multiple unilateral, bilateral, or pelvic lymph nodes, in addition to those presenting with a fixed inguinal mass. Included in the series were patients who were treatment naïve in addition to those patients with either disease recurrence or inadequately treated regional disease.
It was gratifying to note that 39 of 60 patients (65%) responded to chemotherapy utilizing objective criteria. An additional 6 patients (10%) exhibited stable disease. Thus when compared to patients who progressed on chemotherapy (n=14 (23%)) we found that both responders and those with stable disease received a survival benefit from chemotherapy and surgical resection.
The benefit of chemotherapy was seen among patients across all disease burdens, and the initial clinical stage in this cohort was not a predictor of survival. This reinforced the value of response to chemotherapy as a strong prognostic marker for survival.
Recent reports utilizing another taxane-based regimen (docetaxel, cisplatin, and 5 fluorouracil) from two different centers revealed lower overall response rates, poorer survival, and significant toxicity.[2, 3] We previously reported that the TIP regimen was well tolerated with no treatment-related deaths. In the current study we also found that the regimen was relatively well tolerated with no treatment related deaths or patients rendered unable to undergo surgery post chemotherapy.
These data confirm the applicability of a treatment paradigm integrating chemotherapy and surgery in a broad population of patients with regionally advanced penile cancer, and support both the NCCN and the European Association of Urology guidelines for the management of locally advanced penile cancer (multiple, bilateral, fixed or relapsed inguinal nodes.[4, 5] Based on our experience, we have now adopted this treatment regimen as the current standard of care at our institution for patients with regionally advanced penile cancer. In addition in an upcoming international multi-institutional trial in advanced penile cancer (InPACT), the TIP regimen will be utilized as the standard.
- Pagliaro LC, Williams DL, Daliani D, Williams MB, Osai W, Kincaid M, et al. Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy for metastatic penile cancer: a phase II study. Journal of Clinical Oncology. 2010 Aug 20; 28(24): 3851–7.
- Djajadiningrat R, Bergman AM, van Werhoven E, Vegt E, Horenblas S. Neoadjuvant Taxane-Based Combination Chemotherapy in Patients With Advanced Penile Cancer. Clin Genitourin Cancer 2014 June 8: (In press)
- Nicholson S, Hall E, Harland SJ, Chester JD, Pickering L, Barber J, et al. Phase II trial of docetaxel, cisplatin and 5FUchemotherapy in locally advanced and metastatic penis cancer (CRUK/09/001). Br J Cancer; 2013 Oct 29; 109(10): 2554–9.
- NCCN Clinical Practice Guidelines in Oncology: Penile Cancer [Internet]. 1st ed. [cited 2014 Jun 18]. Available from: http://NCCN.org
- Hakenberg OW, Comperat E, Minhas S, Necchi A, Protzel C, Watkin N. EAU Guidelines on Penile Cancer 2014. http://www.uroweb.org/guidelines/online-guidelines/
- Nicholson S, Kayes O, Minhas S. Clinical trial strategy for penis cancer. BJU international. 2014;113(6):852-3. Epub 2013/11/15.
Curtis A. Pettaway, MD as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
The University of Texas M.D. Anderson Cancer Center, Houston, Texas USA