Retrospective Review of Chemotherapy Treatment for Locally Advanced and Metastatic Penile Cancer in the North West of England

Aims: To examine current practices in the UK in the use of chemotherapy in advanced penile cancer and investigate the treatment outcomes of this group of patients.
Study Design: Retrospective series.
Place and Duration of Study: The study population received chemotherapy at Clatterbridge Cancer Centre, The Christie Hospital or Lancashire Teaching Hospital between January 1999 and January 2009.
Methodology: Patients undergoing chemotherapy for histologically confirmed squamous cell carcinoma of the penis within the designated time period were identified retrospectively.
Through case note review, data were collected on chemotherapy regimens, tolerability, response to treatment and survival. Response to chemotherapy was categorized by the investigators according to RECIST (version 1.0) criteria.
Chemotherapy given concurrently with radiotherapy was excluded.
Results: 40 patients were treated with chemotherapy for locally advanced or metastatic penile cancer. Prior to the inception of a Supra-regional Multidisciplinary Team (SMDT), seven different chemotherapy regimens were used first line. After introduction of the SMDT Cisplatin/5-Fluoruracil (5FU) was almost exclusively prescribed outside of clinical trials.
12/40 (30%) patients completed the planned course of chemotherapy. 27/40 (67%) discontinued treatment prematurely, 14/40 (35%) due to progressive disease, and 13/40 (32%) due to declining performance status and/or toxicity.
Response to chemotherapy was assessed radiologically in 23/40 patients and categorised by the investigators according to RECIST criteria. There were three complete responses and eight partial responses (objective response rate 28%). Median survival was 15 months from diagnosis and 5 months from commencing first line chemotherapy.
Conclusion: This supra-regional collaboration highlighted varying use of chemotherapy historically in penile cancer. Development of a supra-regional MDT has reduced much of the variability. Response rates are modest and survival outcomes are poor. This reinforces the urgent need for clinical trials to establish a framework for novel, more active regimens and to guide patient selection.