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LETTER TO THE EDITOR
Year : 2015  |  Volume : 11  |  Issue : 4  |  Page : 1041

Neoadjuvant chemotherapy with cetuximab for locally advanced penile cancer


1 Department of Medical Oncology, Cancer Center, The State Key Laboratory of Biotherapy, Chengdu, China
2 Department of Urology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China

Date of Web Publication15-Feb-2016

Correspondence Address:
Prof. Ji-Yan Liu
Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan Province
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.151945

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How to cite this article:
Luo WX, He JP, Li X, Liu JY. Neoadjuvant chemotherapy with cetuximab for locally advanced penile cancer. J Can Res Ther 2015;11:1041

How to cite this URL:
Luo WX, He JP, Li X, Liu JY. Neoadjuvant chemotherapy with cetuximab for locally advanced penile cancer. J Can Res Ther [serial online] 2015 [cited 2020 Jul 3];11:1041. Available from: http://www.cancerjournal.net/text.asp?2015/11/4/1041/151945

Sir,

Penile squamous cell carcinoma (SCC) is a rare malignancy. [1] Neoadjuvant chemotherapy represents the standard of treatment for patients with locally advanced penile SCC. [2] Recently, our previous study noted that the overexpression of epidermal growth factor receptor (EGFR) was common and mutations of KRAS and BRAF were rare in penile SCC, which suggested anti-EGFR antibody might be potentially beneficial to penile SCC. [3] Here, we describe a patient with locally advanced penile SCC using neoadjuvant chemotherapy with cetuximab (an anti-EGFR antibody).

In November 2013, a 68-year-old man, complaining about masses in his penis and groin, was diagnosed as penile SCC by pathological examination after fine-needle aspiration. Then, the patient received the total penectomy in the local hospital. However, the masses in his groin grew rapidly with secondary bacterial infection [Figure 1]a]. He was referred to our hospital for further treatment in December 2013. Computed tomography showed enlarged soft tissue shadows in his bilateral inguinal region [Figure 2]a and b]. KRAS and BRAF gene status analysis of the tumor showed wild types. Obviously, the tumor was considered unresectable. Then the patient started neoadjuvant therapy with cetuximab 800 mg on day 1 plus chemotherapy with paclitaxel 210 mg on day 1 and cisplatin 30 mg on day 1-3 every 2 weeks, and anti-infection treatment was also performed. After two chemotherapeutic cycles, his tumor achieved a partial response (PR) with a significant reduction in masses size and complete control of the infection [Figure 2]c and d]. After completion of the fourth course of chemotherapy, the swollen lymph nodes shrinked obviously [Figure 1]b]. Then he successfully underwent bilateral inguinal lymph node dissection in April 2014. Histopathological examination revealed that cancerous metastases were found in six lymph nodes. After 2 months recurrence-free time, unfortunately, the patient suffered a tumor recurrence in his right groin.
Figure 1: (a) Pink cutaneous nodular lesions in the groin were red and swollen before cetuximab and chemotherapy. (b) The swollen nodular lesion regression was obvious after cetuximab and chemotherapy

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Figure 2: Computed tomography showing enlarged tissue shadows in the right (a) and left (b) groin region before cetuximab and chemotherapy. Two cycles later, partial response was achieved with a significant reduction in masses size (c and d)

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Although long disease-free time was not achieved in this case, a PR was achieved and bilateral inguinal lymph node dissection was completed. The good clinical response to cetuximab-containing chemotherapy followed by successful radical surgery suggested potential application of cetuximab in neoadjuvant therapy for locally advanced penile SCC. As we know, cisplatin-containing chemotherapy is now considered the first choice in neoadjuvant setting for advanced penile cancer; however, the prognosis of advanced penile SCC is poor. [2],[4] The chemotherapy regimen of three-drug combination likely leads to greater response, but more adverse reactions. In the prospective trial of neoadjuvant chemotherapy for advanced penile SCC (paclitaxel, cisplatin, and ifosfamide), a number of grades 3 and 4 adverse events were occurred. [2] Theoretically, replacing a kind of chemotherapy drug with cetuximab may reduce the overlap of possible adverse effects among chemotherapy drugs. In this case, mild acne-like rashes were observed due to cetuximab-related toxicity and the regimen was well-tolerated.

Given the rarity of the disease, the realization of a prospective trial will be difficult. The experience of treatment for penile SCC should be gathered case by case. Future investigations of anti-EGFR antibody in neoadjuvant setting for locally advanced penile SCC are warranted.

 
 > References Top

1.
Misra S, Chaturvedi A, Misra NC. Penile carcinoma: A challenge for the developing World. Lancet Oncol 2004;5:240-7.  Back to cited text no. 1
    
2.
Pagliaro LC, Williams DL, Daliani D, Williams MB, Osai W, Kincaid M, et al. Neoadjuvant paclitaxel, ifosfamide, and cisplatin chemotherapy for metastatic penile cancer: A phase II study. J Clin Oncol 2010;28:3851-7.  Back to cited text no. 2
    
3.
Gou HF, Li X, Qiu M, Cheng K, Li LH, Dong H, et al. Epidermal growth factor receptor (EGFR)-RAS signaling pathway in penile squamous cell carcinoma. PLoS One 2013;8:e62175.  Back to cited text no. 3
    
4.
Leijte JA, Kerst JM, Bais E, Antonini N, Horenblas S. Neoadjuvant chemotherapy in advanced penile carcinoma. Eur Urol 2007;52:488-94.  Back to cited text no. 4
    


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