Role of paclitaxel and platinum-based adjuvant chemotherapy in high-risk penile cancer

Abstract

Aim:To study the efficacy and safety of paclitaxel and platinum doublet chemotherapy in penile cancer patients with high-risk features of local failure.Materials and Methods:Retrospective analysis was done of patients with 19 carcinoma of the penis who were offered adjuvant chemotherapy with paclitaxel and platinum combination. The data regarding the surgical details, high-risk features for which chemotherapy was offered, chemotherapy toxicity details (in accordance with CTCAE vs 3), failure pattern, and survival data were noted. SPSS version 16 was used for statistical analysis. Descriptive and Kaplan–Meier survival analysis was performed.Results:Median age of patients was 48 years. Fifteen patients received paclitaxel in combination with cisplatin and four received paclitaxel with carboplatin in view of their low serum creatinine clearance. The treatment was completed by 12 patients (63.2%). Of 79 planned cycles, 50 were taken. The treatment was well tolerated with grade 3-4 gastrointestinal toxicity was seen in 1 patient, grade 3 neurological toxicity in one and grade 5 neutropenia in one patient. Treatment related death occured in one patient. The median follow-up was 15.33 months and 6 loco-regional relapsed had taken place. The estimated median DFS was 16.2 months and the estimated median OS was not reached. The estimated DFS for treatment completed patients was 23.13 months as against 2.16 months for patients not completing treatment.Conclusion:The platinum and taxane doublet chemotherapy was found to be safe and effective.

Modification of N staging systems for penile cancer: a more precise prediction of prognosis

“…Based on this assumption, our modified N staging system prevented overtreatment in ∼30% (14/48) of patients with pN2 disease without missing any cases where treatment should have been given. We know that the value of adjuvant chemotherapy after ILND in node-positive penile cancer is heterogeneous ( Pagliaro et al , 2010 ; Noronha et al , 2012 ; Nicholson et al , 2013 ; Sonpavde et al , 2013 ). Adjuvant therapy is not recommended for pN1 cases ( Clark et al , 2014 ; OW Hakenberg and A Necchi, 2014 ).…”

“…Adjuvant therapy is not recommended for pN1 cases ( Clark et al , 2014 ; OW Hakenberg and A Necchi, 2014 ). Multimodal treatment can improve patient outcomes in many tumour entities, and adjuvant chemotherapy is an option for patients with pN2–3 tumours ( Noronha et al , 2012 ; Nicholson et al , 2013 ; Sonpavde et al , 2013 ). We admit that not all of the enroled patients with pN2 tumours were given adjuvant chemotherapy for various reasons, but according to our hypothesis, 14 of the patients who were down-staged to pN1 should not have been recommended to undergo further chemotherapy after ILND.…”

Extent of pelvic lymph node dissection in penile cancer may impact survival

“…Other retrospective series have also demonstrated benefits associated with neoadjuvant therapies, including long-term survival in 37 % of patients who received surgery [12,13]. Small retrospective series have also demonstrated clinical improvements following surgery in patients with nodal metastases (mainly pN2-3) [14,15]. The role of radiotherapy is less well defined.…”

Squamous Cell Carcinoma of the Penis: Fourteen-year Experience from a Tertiary Institution

“…A few small and heterogeneous series reported long-term disease-free survival of 39% to 53% after three to four cycles of adjuvant chemotherapy in patients with pN2-3 disease. 9,12,13 Different chemotherapeutic agents were administered including vincristine, bleomycin and methotrexate; PF; and cisplatin, 5-fluorouracil plus paclitaxel or docetaxel. None of our patients were offered neoadjuvant or adjuvant chemotherapy.…”