Metastatic penile carcinoma – an update on the current diagnosis and treatment options

Barski, Dimitri; Georgas, Evangelos; Gerullis, Holger; Ecke, Thorsten

doi:10.5173/ceju.2014.02.art2

Cited by 40 publications

(45 citation statements)

References 35 publications

(31 reference statements)

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“…Enlarged inguinal lymph nodes can be identified in about 30–60% of the patients with penile cancer at the time of diagnosis, but only about 50% will be related to metastasis and the other half will be reactive ones due to infection . However, false‐positive is not the unique limitation of clinical staging because ∼10–25% of patients with no palpable lymph node can harbor occult metastases …”

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confidence: 99%

“…10,[12][13][14] However, false-positive is not the unique limitation of clinical staging because 10-25% of patients with no palpable lymph node can harbor occult metastases. 6,13,15 Magnetic resonance imaging (MRI) has not been frequently used to evaluate penile cancer. The first reports dated from the early 1990s, 16 but recently interest was renewed, with more studies published.…”

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Incremental value of MRI for preoperative penile cancer staging

Lucchesi

Reis

Faria

et al. 2016

J. Magn. Reson. Imaging

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Incremental value of MRI for preoperative penile cancer staging

Lucchesi

Reis

Faria

et al. 2016

J. Magn. Reson. Imaging

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“…Due to recent advances in diagnostic modalities such as fine-needle biopsy (FNB) and dynamic sentinel node biopsy (DSNB), stratification of patients with penile cancer has enabled clinicians to ascertain important features of penile cancer that impact the treatment course [1]. Despite this, prognosis remains poor for patients with penile cancer.…”

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confidence: 99%

Machine learning algorithm for early mortality prediction in patients with advanced penile cancer

Chen

Kudelka

Rosado

et al. 2020

Preprint

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Penile cancer remains a rare cancer with an annual incidence of 1 in 100,000 men in the United States, accounting for 0.4-0.6% of all malignancies. Furthermore, to date there are no predictive models of early mortality in penile cancer. Meanwhile, machine learning has potential to serve as a prognostic tool for patients with advanced disease. We developed a machine learning model for predicting early mortality in penile cancer (survival less than 11 months after initial diagnosis. A cohort of 88 patients with advanced penile cancer was extracted from the Surveillance, Epidemiology and End Results (SEER) program. In the cohort, patients with advanced penile cancer exhibited a median overall survival of 21 months, with the 25th percentila of overall survival being 11 months. We constructed predictive features based on patient demographics, staging, metastasis, lymph node biopsy criteria, and metastatic sites. We trained a multivariate logistic regression model, tuning parameters with respect to regularization, and feature selection criteria. Upon evaluation with 5-fold cross validation, our model achieved 68.2% accuracy with AUC 0.696. Criteria for advanced staging (T4, group stage IV), as well as higher age, white race and squamous cell histology, were the most predictive of early mortality. Tumor size was the strongest negative predictor of early mortality. Our study showcases the first known predictive model for early mortality in patients with advanced penile cancer and should serve as a framework for approaching the clinical problem in future studies. Future work should aim to incorporate other data sources such as genomic and metabolomic data, increase patient counts, incorporate clinical characteristics such as ECOG and RECIST criteria, and assess the performance of the model in a prospective fashion.

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“…In general, for the treatment of metastatic penile cancer, systemic chemotherapy, radiation therapy or chemoradiation can be considered [12]. Given the rarity of penile cancer, there are no randomized clinical trials to define the preferred chemotherapeutical regimen [13,14].With the tsunami of checkpoint inhibitors during the last 3 years, these potent anticancer agents showed remarkable results in the management of different malignancies. During the last few years, checkpoint inhibitors were approved in melanoma, non-small-cell lung cancer, bladder cancer, squamous cell head and neck cancer, renal cell carcinoma and Hodgkin's lymphoma.…”

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Do Checkpoint Inhibitors Provide New Hope for Management Of Metastatic Penile Carcinoma?

et al. 2018

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Penile carcinomas are rare in the USA, Europe and other industrialized countries [1]. In contrast, their incidence is significantly higher in some less developed countries in South America, Africa and Asia, accounting for as much as 10-20% of male cancers [2,3]. The annual incidence of penile squamous cell carcinoma (SCC) increases with age, with a median age of 68 years [4,5]. Many factors are known to increase the risk of developing a precursor lesion or a SCC of the penis, such as phimosis, HPV, HIV and tobacco exposure [6][7][8][9]. A number of medical conditions are also associated with an increased risk of developing penile cancer: a history of penile injury, tear, or chronic rash lasting one month or longer; a history of urethral structure, urinary tract infection or genital warts [8]. It is interesting to note that sexual orientation (heterosexual, bisexual/homosexual) is not a risk factor for penile cancer [9].The majority of penile cancers are diagnosed at a local stage (61%); these cancers are characterized by early locoregional spread with subsequent potential for distant dissemination [10]. Disseminated metastatic penile cancers are treated based on the localizations of the metastases, the symptoms of the patients and their performance status [11]. In general, for the treatment of metastatic penile cancer, systemic chemotherapy, radiation therapy or chemoradiation can be considered [12]. Given the rarity of penile cancer, there are no randomized clinical trials to define the preferred chemotherapeutical regimen [13,14].With the tsunami of checkpoint inhibitors during the last 3 years, these potent anticancer agents showed remarkable results in the management of different malignancies. During the last few years, checkpoint inhibitors were approved in melanoma, non-small-cell lung cancer, bladder cancer, squamous cell head and neck cancer, renal cell carcinoma and Hodgkin's lymphoma. They were tested in rare cancers where no strong standard of care treatment was present [15].We aimed in this paper to first describe the standard treatment of metastatic penile cancer. Given the fact that checkpoint inhibitors are demonstrating promising results in different malignancies, we then focused on their potential role in the management of this rare disease based on histology, risk factors and ongoing trials results.The rationale behind the use of checkpoint inhibitors in metastatic penile cancers In the absence of highly efficient therapies in the treatment of metastatic penile carcinoma, this rare tumor seems to be an interesting landscape for exploring checkpoint inhibitors. Different histologic, epidemiologic and therapeutic aspects encouraged researchers to test this drug in this malignancy. In fact, checkpoint inhibitors showed interesting results in virus-induced cancer, namely those related to HPV in SCC of the head and neck, the cervix and the anus [16]. This is mainly attributed to a specific immunologic profile probably related to a higher mutational load of these tumors and a higher expression of PD-...

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Metastatic penile carcinoma – an update on the current diagnosis and treatment options

Cited by 40 publications

References 35 publications

Incremental value of MRI for preoperative penile cancer staging

Incremental value of MRI for preoperative penile cancer staging

Machine learning algorithm for early mortality prediction in patients with advanced penile cancer

Do Checkpoint Inhibitors Provide New Hope for Management Of Metastatic Penile Carcinoma?

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