NEW ORLEANS, LA USA (UroToday.com) - Philippe Spiess discussed new treatments in penile cancer and the updated NCCN guidelines for the disease. He first reiterated the importance and rationale for developing standardized guidelines for rare diseases like penile cancer. The guidelines were developed by a small cohort of clinicians and then reviewed and revised by several internationally recognized experts.
First risk factors for the disease were identified and T stage was assigned. Grading is important for T1 tumors and exam is necessary for all patients. Penile-sparing approaches are now favored in surgical management of T1 and some T2 tumors. In higher stage disease, however, more radical therapy is often required. For nonpalpable inguinal nodes, risk assignment of nodal metastasis is necessary. For low-risk patients, surveillance is adequate, with salvage surgery as needed. For intermediate- or high-risk patients, prophylactic adenectomy is recommended. There is evolving data on sentinel node biopsy but there is still debate regarding the meaning of a negative biopsy. If disease is palpable, initial biopsy is favored, but adenectomy is to be strongly considered even if it is negative when the pretest probability is high. Neoadjuvant chemotherapy is gaining traction for bulky or bilateral disease. Pelvic node dissection indications are nonuniform. For postsurgical surveillance, retrospective studies provide some guidance. Biannual exam is adequate for patients with resection, but if topical therapy was used, then patients should be followed more closely. For patients with resected nodal disease, close follow up is also required. Most recurrences will be identified within the first year. PETCT is also gaining momentum in follow up, especially when exam is difficult. For local recurrences, surgery, radiation, and chemotherapy are all viable options in the absence of quality data to guide decision making. For systemic disease, surgery can only be recommended in complete responders after a period of observation without recurrence.
Dr. Spiess then discussed the InPACT trial which is an ECOG study led by Curtis Pettaway to determine the efficacy or requirement of neoadjuvant chemotherapy or chemoradiotherapy. Patients with clinical evidence of inguinal disease will be assigned to immediate adenectomy, neoadjuvant chemotherapy, or neoadjuvant chemoradiotherapy. Patients who receive immediate adenectomy will receive adjuvant chemotherapy if they have high risk for recurrence. The primary endpoint is survival, with several secondary endpoints. There are 20 American sites with an accrual goal of 200 patients. Surgeons and imaging studies will require central validation for quality to ensure inter-institutional uniformity in treatment. The study should start in Janurary 2016.
Presented by Philippe Spiess, MD at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Moffitt Cancer Center, Tampa, FL USA
Reported by Phillip Abbosh, MD, PhD, medical writer for UroToday.com