ASCO GU 2017: Year in Review: Penile Cancer

Orlando, Florida USA (UroToday.com) According to Dr. Asif Muneer, penile cancer is a deadly disease. Therefore, misdiagnosis and undertreatment are major reasons for progression. In the United Kingdom, the number of cases increases over time. The National Cancer Institute’s Surveillance, Epidemiology, and End Results Program, also called SEER, has data showing that ethnicity is extremely important, with patients who are Hispanic, Native American, and African Americans having worse prognoses. Data from the National Cancer Database showed that African Americans present at higher stages and have worse overall survival. Despite many advances in treating such individuals, the 5-year survival has not changed significantly. Advanced disease is not managed correctly, as the Eunice study indicates.

Human papillomavirus (HPV) has been found in more than 50% of penile cancer patients, depending on the viral subtype (with 16,18,6,11 being the most common). HPV occurs more frequently in the invasive penile cases compared with the noninvasive disease. Dr. Muneer indicated that the role of HPV vaccination is not clear. Men do not develop antibodies to HPV, whereas women do. However, vaccination has been shown to reduce HPV-related lesions.
Mutations have been identified in penile cancer, which is a very heterogeneous disease in terms of identified changes. There is a very low proportion of recurrent mutations, with the most commonly mutated genes being TP53 and CDKN2A, among others. Furthermore, a high HPV load is associated with a lower number of mutations. A recent study showed that epidermal growth factor receptor or EGFR expression was increased in more than 90% of samples. Programmed death-ligand-1 overexpression was found in over one-half of samples. Programmed death-ligand-1 was also found to be a prognostic marker for survival and lymph-node status. All these changes at the genome and proteome levels will allow for targeted therapy in the future.

In conclusion, Dr. Muneer indicated it is well-known that inguinal-node status is a major prognostic indicator. Patients with nonpalpable nodes (cN0) have occult micrometastases in 12% to 25% of cases. This fact highlighted the need for lymph-node assessment in all instances, with 5-year survival being significantly higher for pN0 compared with pN+. The two main options for node assessment are inguinal lymph-node dissection (ILND) and dynamic sentinel lymph-node biopsy, whichis a highly specialized procedure that should be performed in dedicated centers only. The technique has low false-negative and complication rates, with its primary appeal being the prevention of the morbidity of ILND in more than 80% of cN0 patients. A recent trial compared open and laparoscopic ILND, with the latter version seeming to reduce wound complication rates and lengths of stay compared with open ILND, so it has become the standard of care in most centers.

Presenter: Asif Muneer, MD, UCLH, UK, University College London Hospital

Written By: Miki Haifler, MD, M.Sc, Fox Chase Cancer Center

at the 2017 Genitourinary Cancers Symposium - February 16 - 18, 2017 – Orlando, Florida USA

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