Salvage treatment for metastatic penile cancer after first-line chemotherapy with paclitaxel, ifosfamide, and cisplatin: Analysis of response and survival outcomes.

Abstract

340 Background: There are few effective salvage treatment options for men with advanced metastatic penile cancer. Patients who remain disease-free for 2 years after surgical removal of regional lymph node metastases are likely cured of the disease, but the survival is short for those who recur. Our objective was to estimate the efficacy of salvage treatments for metastatic penile cancer after neoadjuvant paclitaxel, ifosfamide, and cisplatin. Methods: Patients are from a 30-patient cohort who we saw between April 2000 and September 2008 presenting with stage TxN2-3M0 squamous cell carcinoma of the penis. All were treated with 1 to 4 courses of neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy prior to planned lymphadenectomy. For the patients who had progression or recurrence of disease, we retrospectively evaluated the salvage therapies given, response data, and survival times from the date of first progression. Results: Nineteen of the 30 patients (63.3%) had tumor progression and 17 received one or more salvage therapies. Median age at diagnosis was 57 years (range 24-72 years). The median survival from time of first progression was 5.8 months (range 3.7 to 30.9 months). Two of five patients (40%) who had received bleomycin, methotrexate, and cisplatin experienced an objective response (1 complete and 1 partial), and one (20%) developed pneumonitis. Two patients had received gemcitabine combinations without response. Two patients had received epidermal growth factor receptor-targeted therapy with gefitinib or cetuximab and cisplatin, both without response. Three patients had received chemo-radiotherapy, one with stable disease for 13.5 months and 2 with no apparent benefit. Five patients underwent salvage surgery, and they all progressed within 2 months with one case of fatal hemorrhage. Conclusions: Men with metastatic penile cancer that progresses through or recurs after front-line neoadjuvant chemotherapy have poor responses to the described salvage treatments, and median overall survival is less than 6 months. Emphasis should be placed on clinical trials for development of effective therapy in this setting.