Treatment trends and outcomes for penile cancer

By Robyn Boyle, RPh, for MDLinx
Published March 26, 2018

Key Takeaways

According to a review published in JAMA Oncology, a lymph node dissection (LND) was associated with improved overall survival in patients with lymph-node–positive (LN+) penile cancer. Chemotherapy or radiotherapy did not influence survival.

Squamous cell carcinoma of the penis is a rare and aggressive disease with limited evidence available to guide therapy. Currently, the National Comprehensive Cancer Network (NCCN) consensus panel recommends LND and/or radiotherapy with consideration of preoperative chemotherapy for patients with LN+ penile cancer, although the rate of LND in these patients remains lower than expected.

To determine trends in the use of chemotherapy as well as to evaluate survival outcomes for patients receiving LND, chemotherapy, or radiotherapy, Shreyas S. Joshi, MD from the Fox Chase Cancer Center, Temple Health in Philadelphia, PA, and colleagues, reviewed information from 1,123 patients with LN+ cancer of the penis using the US National Cancer Database (NCDB).

Most patients were white (82.3%), between the ages of 50 and 75 years (64.7%), and underwent LND (66.8%). Treatment with chemotherapy was similar for patients who received LND and for those who did not (40.4% vs 42.4%, respectively).

During the ten-year study period, chemotherapy use increased from 38.2% in 2004 to 47.8% in 2014 (P  < 0.001). In contrast, the use of radiotherapy was 36.8% in 2007 and fell to 23.5% by 2014.

Patients with a higher node category were more likely to receive chemotherapy—52.8%, 39.6%, and 31.4% with N3, N2, and N1 cancer, respectively, received chemotherapy. Nodal status predicted an increased likelihood of receiving chemotherapy as the node category increased. For N2 and N3 cancer, the odds ratio (OR) was 1.54 and 2.15, respectively.

After adjustment, patients older than 76 years of age were less likely to receive chemotherapy (OR=0.28, P < 0.001), and treatment with radiotherapy was strongly associated with chemotherapy use (OR, 4.38, P  < 0.001).

Overall survival was higher in patients undergoing LND (hazard ratio [HR], 0.64; P  < 0.001). Reduced survival was associated with an age of 76 years or older (HR, 1.92; P =0.001) and node categories N2 (HR, 1.44; P=0.001) and N3 (HR, 1.93; P  < 0.001).

Median overall survival varied from 14.5 months with treatment of chemotherapy without LND or radiation to 44.6 months with treatment of LND and chemotherapy without radiotherapy.

Receiving chemotherapy or radiotherapy was not associated with overall survival. Moreover, there was no significant survival effect of chemotherapy by node category.

In patients who underwent LND, no difference in survival was noted with the addition of chemotherapy (P=0.77) or radiotherapy (P=0.99).

The authors acknowledge that using retrospective data from the NCDB limited the study in some ways. Comprehensive patient information was not available for analysis, and specific chemotherapy regimens could not be identified and evaluated. In addition, survival outcomes of early vs late LND could not be assessed. It was also not possible to differentiate inguinal from pelvic LND, and the observational study may have been subject to various biases.

Because advanced penile cancer is rare, the authors suggested that centralization of care may optimize the multidisciplinary management of the disease.

“Although LND is associated with improved survival, neither chemotherapy nor radiotherapy appears to correlate with overall survival in this heterogeneous cohort, potentially because of a small sample size,” concluded the investigators.

They propose that this information could help to improve adherence to recommended treatment guidelines for LN+ penile cancer as well as to influence future clinical trials.

To read more about this study, click here

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