Systematic Review and Meta-Analysis—Is there a Benefit in Using Neoadjuvant Systemic Chemotherapy for Locally Advanced Penile Squamous Cell Carcinoma?

Abstract

Purpose: Neoadjuvant chemotherapy (NAC) is a recommended treatment in penile cancer patients with bulky inguinal lymphadenopathy or unresectable primary tumors although there is no evidence of its benefit from randomized trials. Patient and Methods: We conducted a systematic search in Embase and MEDLINE for studies reporting on patients who received preoperative NAC for locally advanced PSCC. Objective response rate (ORR), pathologic complete response (pCR), grade ≥3 toxicity and overall mortality (OM) were evaluated in terms of NAC type, which was dichotomized as non-taxane-platinum (NTP) and taxane-platinum (TP) regimens. Results: Overall, 10 studies met the inclusion criteria enrolling a total of 182 patients; 66 (36.3%) and 116 (63.7%) were treated with NTP and TP regimens, respectively. The pooled results demonstrated ORR of 53% (95% CI: 42%–64%) pCR of 16%, grade ≥3 toxicity rate of 40% (95% CI: 19%–64%) and OM of 55% (95% CI: 40%–70%) in patients treated with NAC. Stratified sub-analysis revealed an ORR of 55% and 49%; a pCR of 9% and 20%; a toxicity rate of 26% and 49%; and an OM of 54% and 58% for NTP vs. TP regimens, respectively. Conclusion: The pooled findings in this study suggest that approximately 50% of the patients with bulky regional lymph node metastases from penile cancer respond to platinum-based NAC and approximately 16% of patients achieve a pCR. Non-taxane based regimens appear to be better tolerated than taxane regimens based on reported grade ≥III adverse events (26% vs 49%). Ultimately, the robustness of these observations should be interpreted with an awareness of the inherent limitations of deriving data from a collection of small, heterogeneous series.