Feasibility and effectiveness of second-line chemotherapy with mitomycin C in patients with advanced penile cancer

BackgroundTriple-drug cisplatin- and taxane-based chemotherapy is the standard treatment for metastatic penile squamous cell cancer (PeSCC), with a moderate response rate of 30% to 38%. Relapse after first-line chemotherapy has a poor prognosis and there is no established second-line treatment. Mitomycin C (MMC) is used as an effective chemotherapy in squamous cell carcinoma of other localities. We therefore used MMC as a single agent for the second-line treatment for patients with advanced PeSCC.MethodsNine patients [median age 63 years (range 31 years–81 years)], who, after inguinal and pelvic lymphadenectomy and progression after first-line chemotherapy, received second-line treatment with 20 mg of MMC administered intravenously and weekly, were included in this study. The median number of cycles of MMC was 6 (range 2–12 cycles) and the median cumulative dose was 120 mg absolute (range 40 mg absolute–240 mg absolute). The patients’ toxicity and treatment responses were evaluated, with the latter evaluated using 18F-FDG-PET/CT.ResultsCommon Terminology Criteria for Adverse Events (CTCAE) grades 3 or 4 thrombocytopenia and grades 2 or 3 leukopenia occurred in all patients, as did anemia. In seven patients, the application interval had to be extended due to thrombocytopenia. Stable disease was achieved in two patients, and all others progressed under treatment. Seven patients died of the disease, with most patients dying 6 months after starting MMC therapy. Of the two patients who responded with disease stabilization, one died of progressive disease 14 months after MMC treatment. The other responding patient has been stable for over 1 year and is still receiving treatment, which he tolerates well, and has a good quality of life.ConclusionMMC has only moderate efficacy as a second-line treatment in patients with metastatic PeSCC. With MMC treatment, hematological toxicity is marked

Clinical Outcomes of Perioperative Chemotherapy in Patients With Locally Advanced Penile Squamous-Cell Carcinoma: Results of a Multicenter Analysis

Patients with locally advanced penile squamous-cell carcinoma have a poor prognosis. No difference in survival was noted when using chemotherapy before or after surgery. Uncertainties persist regarding the optimal management of these patients, and new treatments are urgently required, particularly for patients at highest risk, with bilateral and/or pelvic lymph node involvement. Background: The prognosis of patients with locally advanced penile squamous-cell carcinoma is primarily related to the extent of lymph node metastases. Surgery alone yields suboptimal results, and there is a paucity of data on these patients' outcomes. Patients and Methods: This retrospective study evaluated patients who received neoadjuvant or adjuvant chemotherapy from 1990 onward at 12 centers. Cox models were used to investigate prognostic factors for relapse-free survival and overall survival (OS). Results: Among the 201 included patients, 39 (19.4%) had disease of T3-4 and N0 clinical stage; the remaining patients had clinical lymph node involvement (cN+). Ninety-four patients received neoadjuvant chemotherapy (group 1), 78 received adjuvant chemotherapy (group 2), and 21 received both (group 3). Eight patients for whom the timing of perioperative chemotherapy administration was unavailable were included in the Cox analyses. Forty-three patients (21.4%) received chemoradiation. Multivariate analysis for OS (n = 172) revealed bilateral disease (P = .035) as a negative prognostic factor, while pelvic cN+ tended to be nonsignificantly associated with decreased OS (P = .076). One-year relapse-free survival was 35.6%, 60.6%, and 45.1% in the 3 groups, respectively. One-year OS was 61.3%, 82.2%, and 75%, respectively. No significant differences were seen on univariable analyses for OS between the groups (P = .45). Platinum type of chemotherapy and chemoradiation were not significantly associated with any outcome analyzed. Conclusion: Benchmark survival estimates for patients receiving perioperative chemotherapy for locally advanced penile squamous-cell carcinoma have been provided, with no substantial differences observed between neoadjuvant and adjuvant administration. This analysis may result in improved patient information, although prospective studies are warranted. (C) 2017 Elsevier Inc. All rights reserved