Presurgical Chemo Improved Penile Cancer Survival

Patients with locally advanced penile squamous cell carcinoma who responded to neoadjuvant (presurgical) chemotherapy followed by consolidative lymphadenectomy (surgical removal of the lymph nodes) experienced improved long-term survival outcomes, researchers have determined.

Study findings recently published in JNCI: Journal of the National Cancer Institute showed that among 209 patients who received neoadjuvant chemotherapy for locally advanced and clinically node-positive penile squamous cell carcinoma — 7% of whom had stage 2 disease, 48% of whom had stage 3 disease and 45% of whom had stage 4 disease — with the majority of patients (201, or 97%) completing planned lymphadenectomy, the median overall survival (the time a patient lives following treatment, regardless of disease status) was 37 months and the median progression-free survival (the time a patient lives without their disease spreading or worsening) was 26 months.

The study’s objective response rate (the patients whose disease responded partially or completely to treatment) was 57.2%, including 87 patients (43.2%) who experienced a partial response and 28 patients (13.9%) who experienced a complete response.

Researchers noted that patients who had an objective response to neoadjuvant chemotherapy had a median overall survival time of 73 months, more than four times longer than the 17-month median overall survival among patients who did not have an objective response to neoadjuvant chemotherapy.

While grade 2 treatment-related side effects occurred in 35 patients (17%), no treatment-related mortality was observed, according to the study’s authors.

There will be approximately 2,100 new cases of penile cancer diagnosed and approximately 500 deaths from penile cancer in 2024, according to the American Cancer Society, which also stated that approximately 95% of penile cancers start on squamous cells, which are flat skin cells, and usually start on the foreskin or on the glans.

In related news for patients with this cancer type, research recently published in the Journal of the National Cancer Institute found that treatment via immune checkpoint inhibitors — immunotherapy drugs that prevent cancer cells from hiding from the immune system — showed that 13% of patients responded to immunotherapy, with an average overall survival of 9.8 months and an average progression-free survival of 3.2 months.

Penile cancer, when localized — meaning it is confined to the penis — has a five-year survival rate of 79%, according to the American Cancer Society, drawing on data from patients diagnosed between 2012 and 2018. However, those numbers drastically decline as the disease spreads, with the regional (the cancer has spread to nearby structures or lymph nodes) five-year survival rate being 51% and the distant (the cancer has spread to distant parts of the body) five-year survival rate being 9%, making for a combined five-year survival rate of 65%.

Five-year relative survival rates have declined over time, from 67.7% for 2000 to 2004 to 65.67% from 2010 to 2014, according to a study published in Frontiers in Oncology.

“We have not developed, nor have we identified, very effective systemic therapies for patients with penile cancer. Oftentimes, we can cure early penile cancer, fortunately,” Dr. Philippe E. Spiess, an assistant chief of surgical services and senior member in the Department of Genitourinary Oncology at Moffitt Cancer Center, told CURE®’s sisterpublication, OncLive® in 2022. “However, when patients have advanced disease, I think we are still very challenged in identifying good chemotherapies or immunotherapies or combination treatments that are going to be very effective for patients.”

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