|LETTER TO THE EDITOR
|Year : 2015 | Volume
| Issue : 4 | Page : 1041
Neoadjuvant chemotherapy with cetuximab for locally advanced penile cancer
Wu-Xia Luo1, Jian-Ping He1, Xiang Li2, Ji-Yan Liu1
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 Publication||15-Feb-2016|
Prof. Ji-Yan Liu
Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan Province
Source of Support: None, Conflict of Interest: None
|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
Penile squamous cell carcinoma (SCC) is a rare malignancy.  Neoadjuvant chemotherapy represents the standard of treatment for patients with locally advanced penile SCC.  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.  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. , 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.  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.
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[Figure 1], [Figure 2]