Treatment of Locally Advanced Penile Squamous Cell Carcinoma When Surgical Resection Is Not Feasible

When penile squamous cell carcinoma presents at a locally advanced stage that is not amenable to upfront surgical resection, a specific systemic strategy is required to address the extent of disease and evaluate whether surgery may become possible.

Clinical scenario

Locally advanced penile squamous cell carcinoma that is not surgically resectable at presentation. Management aims to downstage disease sufficiently to allow subsequent surgical intervention, or to provide disease control for patients in whom surgery remains unfeasible or is declined.

Treatment approach

The preferred approach involves induction chemotherapy using a cisplatin- and taxane-based combination regimen, with the goal of downstaging disease. Surgical resection is then offered to patients who respond. Specific regimen options, cycle counts, and management of non-responders are detailed in the full protocol.

Complete regimen, sequencing, and eligibility criteria for surgery are in the full protocol →

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References

Non-resectable disease: offer induction chemotherapy followed by surgery to responders, or chemoradiotherapy to patients with non-resectable advanced primary lesions, or to patients with locally advanced disease who refuse surgical management.
In non-resectable disease, induction chemotherapy offers the ability to downstage disease and thereby enable surgical resection among responders, even among men with advanced penile cancer.
Several retrospective and prospective series have evaluated the effects of combination regimens using paclitaxel or docetaxel with cisplatin and ifosfamide or 5-FU.
A phase II trial evaluated treatment with four cycles of neoadjuvant TIP in patients with clinical N2 or N3 LN metastases.
The limited available evidence favours a cisplatin- and taxane-based combination (doublet or triplet) as the preferred preoperative approach.

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