Multimodal Approach to Locally Advanced and Metastatic Penile Cancer

Abstract

Squamous cell carcinoma of the penis is a rare cancer, with inguinal lymph node metastasis being the most important prognostic factor for the disease. Loco-regionally advanced disease has traditionally been managed by surgery and postoperative radiotherapy, but a multimodal approach to treatment has evolved over the past 20 years. The latest evidence suggests that neoadjuvant platinum-based triplet systemic chemotherapy can provide good outcomes for men with bulky or initially unresectable nodal metastases, with response rates as high as 65 %, enabling consolidation surgery in a fair proportion of men and achieving pathologic complete responses in 10–16 %. Nevertheless, survival outcomes for men with locally advanced or metastatic disease are moderate, with a 5-year overall survival of 50 % being the best outlook for men who respond to neoadjuvant chemotherapy, which represents an improvement on historical survival rates. The past few years have seen greater emphasis on determining the effect of human papillomavirus infection in penile cancer and outlining prognostic cohorts, together with investigation of targeted therapy, mainly for metastatic disease. It is hoped that multi-institutional collaboration within the International Rare Cancers Initiative will provide the first randomized data on men with locally advanced or metastatic disease, and outline novel treatment paradigms of how the integration of systemic chemotherapy, radiotherapy, surgery, and targeted therapy can be effectively used in a multimodal manner.