Longitudinal cohort analysis of patients with metastatic penile cancer treated in a large quaternary academic centre

Abstract

Objective: This study aimed to provide real-world data on the multidisciplinary management of metastatic penile squamous-cell carcinoma (mpSCC) patients and their survival outcomes, particularly those who receive best supportive care (BSC). Methods: A retrospective analysis of 1720 patients, managed via a supra-regional penile-specialist multidisciplinary team was conducted between January 2006 and May 2020. Results: A total of 101 patients (median age 63 years; interquartile range 56–72 years; 73% ECOG 0/1) were included. Of these, 32% (32/101) had previously received adjuvant chemotherapy prior to metastatic recurrence, 58% (59/101) received chemotherapy and 42% (42/101) received BSC. Further, 17% (17/101) received second-line systemic therapy, and 3% (3/101) received third-line systemic therapy. For first-line systemic-therapy, there was a 46% (27/59) clinical benefit rate (CBR), with 9% (5/59) complete response, 15% (9/59) partial response and 22% (13/59) stable disease. Patients receiving second-line therapy ( n=17) had a 29% (5/17) CBR. Median progression-free survival for first- and second-line treatment was 3.2 and 2.2 months, respectively. Median overall survival (mOS) for all patients was 6.2 months. mOS for first-line chemotherapy, second-line chemotherapy and BSC patients was 7.2, 4.5 and 2.0 months, respectively. Conclusions: First-line platinum-based chemotherapy is associated with notable response rates in mpSCC patients. Agents with better response rates are needed urgently potentially in combination with platinum-based chemotherapy. Level of evidence: Level 2b.

Penile Cancer: EAU-ASCO Collaborative Guidelines Update Q and A

“…39 Two studies of various second-line systemic therapy regimens found a median OS of 4.5 to 5.6 months. 35,40 Given the relatively high expression of PD-L1 in penile SCC, studies have been initiated. Preliminary data for anti-PD(L)1 monotherapy trials reported an ORR of 14%-17%, including the first published dedicated prospective phase 2 study.…”

“…32 Retrospective studies of cisplatin and fluorouracil had an ORR of 32% and a median OS of 8 months, 33 and carboplatin and paclitaxel have retrospective data in metastatic and locally advanced settings. [34][35][36] A systematic review of cisplatin regimens with and without taxanes suggested higher toxicity rates with taxanes, 49% versus 26%. 37 Toxicity is a concern for combination chemotherapy, especially since there are little prospective data showing significant survival benefit, underscoring the importance of patient selection.…”

“…39 Two studies of various second-line systemic therapy regimens found a median OS of 4.5 to 5.6 months. 35,40…”