Abstract
Background
The role of chemotherapy in nodal metastases from penile squamous cell carcinoma is
not defined. We evaluated the efficacy of a combination of T-PF (a taxane, cisplatin,
and 5-fluorouracil) in neoadjuvant and adjuvant settings.
Patients and Methods
Since June of 2004, T-PF was administered to stage N2 to 3 patients. With time, neoadjuvant
chemotherapy administration prevailed with respect to use in the adjuvant setting.
Primary end points were progression-free (PFS) and overall (OS) survival. Secondary
objectives were tolerability and activity in the neoadjuvant setting. Nonparametric
tests, Kaplan–Meier, and regression analyses were performed.
Results
As of October of 2012, 47 consecutive N2 to 3 M0 patients had undergone neoadjuvant
(n = 28) or adjuvant (n = 19) T-PF: 18 patients (38.3%) remain disease-free after
a median follow-up of 22 months (interquartile range, 17-42 months). The 2-year disease-free
survivals were 36.8% (95% confidence interval [CI], 15.2-58.5) versus 7.1% (95% CI,
0-16.7) after adjuvant and neoadjuvant therapy, respectively. N3 metastases were associated
with a poorer PFS, and bilateral metastases and mutated p53 were associated with a
poorer OS. After neoadjuvant treatment, 43% clinical responses and 14% complete pathologic
remissions were recorded, but responses were not associated with survival. Neutropenia
(25.5%) was the most frequent Grade ≥ 2 toxicity.
Conclusion
The T-PF regimen is well tolerated and compares with other regimens in terms of activity
and efficacy in the neoadjuvant setting, and very long survivals have been recorded
after adjuvant administration. The role of perioperative treatment in these patients
remains controversial. Some caution in administering preemptive treatment in patients
with resectable disease is needed.
Keywords
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Article info
Publication history
Published online: August 06, 2015
Accepted:
July 30,
2015
Received:
April 3,
2015
Footnotes
Giorgio Pizzocaro, Emeritus.
Identification
Copyright
© 2015 Elsevier Inc. All rights reserved.
