Wang Jennifer, Pettaway Curtis A, Pagliaro Lance C
Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Urology. 2015 May;85(5):1104-1110. doi: 10.1016/j.urology.2014.12.049. Epub 2015 Mar 25.
To retrospectively estimate the efficacy of various treatments used in men with metastatic penile cancer that progresses after first-line chemotherapy.
Patients were from a 30-patient cohort with stage TxN2-3M0 penile squamous cell carcinoma treated with neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy before planned lymphadenectomy. Nineteen patients (63.3%) had tumor progression or recurrence, and we evaluated the response to subsequent treatment and survival.
Seventeen had received ≥ 1 salvage therapies; their median survival from first treatment failure was 5.7 months (range, 1.4-30.3 months). Four patients underwent salvage surgery, all of whom experienced further disease progression within 2 months. Four patients received chemoradiotherapy, 1 with stable disease for 13.5 months and 3 with no apparent benefit. Two of 5 evaluable patients (40%) who had received bleomycin, methotrexate, and cisplatin had objective responses (1 complete, 1 partial) but 1 developed fatal pneumonitis. There were no other documented responses to systemic therapy. Median overall survival was 5.6 months for patients who had received a second cisplatin-based treatment at any time and 4.3 months for those who had not (P = .4).
Patients whose metastatic penile carcinoma progresses through or recurs after front-line cisplatin-based chemotherapy experience poor responses to the described salvage treatments, with a median overall survival time of <6 months. Emphasis should be placed on clinical trials for development of effective therapy in this setting.
回顾性评估用于一线化疗后病情进展的转移性阴茎癌男性患者的各种治疗方法的疗效。
患者来自一个30例患者的队列，患有TxN2 - 3M0期阴茎鳞状细胞癌，在计划进行淋巴结清扫术前接受了新辅助紫杉醇、异环磷酰胺和顺铂化疗。19例患者（63.3%）出现肿瘤进展或复发，我们评估了他们对后续治疗的反应和生存情况。
17例患者接受了≥1次挽救性治疗；他们从首次治疗失败起的中位生存期为5.7个月（范围1.4 - 30.3个月）。4例患者接受了挽救性手术，所有患者均在2个月内出现疾病进一步进展。4例患者接受了放化疗，1例疾病稳定13.5个月，3例无明显获益。5例可评估的接受博来霉素、甲氨蝶呤和顺铂治疗的患者中有2例（40%）出现客观反应（1例完全缓解，1例部分缓解），但1例发生致命性肺炎。未记录到其他对全身治疗的反应。随时接受第二次基于顺铂治疗的患者的中位总生存期为5.6个月，未接受者为4.3个月（P = 0.4）。
转移性阴茎癌经一线基于顺铂的化疗后病情进展或复发的患者，对所述挽救性治疗反应不佳，中位总生存时间<6个月。应重点开展针对该情况开发有效治疗方法的临床试验。
