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Simon N, Atiq S, Sonpavde G, Apolo A. New Therapeutic Horizons for Advanced or Metastatic Penile Cancer. Urol Clin North Am 2024; 51:367-376. [PMID: 38925739 DOI: 10.1016/j.ucl.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
Penile cancer is a rare malignancy with a poor prognosis. Studies with single-agent immune checkpoint inhibitors (ICIs) have demonstrated efficacy, but response rates are low. Studies combining ICIs with both chemotherapy and targeted therapy are ongoing. Up to 50% of penile cancer cases are associated with human papillomavirus (HPV). HPV-targeting therapies, such as HPV-targeting vaccines and T-cell receptor therapies, are an area of active investigation. Penile cancer cells also express cell surface antigens that may be targeted by the emerging class of antibody-drug conjugates.
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Affiliation(s)
- Nicholas Simon
- Department of Oncology, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive Building 10, Room 12C432B, Bethesda, MD 20892, USA
| | - Saad Atiq
- Department of Oncology, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10 - Magnuson Clinical Center, Room B2L312, Bethesda, MD, 20892, USA
| | - Guru Sonpavde
- Department of Urology, AdventHealth Cancer Institute, University of Central Florida, 2501 North Orange Avenue, Orlando, FL 32804, USA
| | - Andrea Apolo
- Department of Oncology, Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Building 10 - Magnuson Clinical Center, Room 13N240, Bethesda, MD 20892, USA.
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Al Assaad M, Safa H, Mercinelli C, Spiess PE, Necchi A, Chahoud J. Immune-based Therapies for Penile Cancer. Urol Clin North Am 2024; 51:355-365. [PMID: 38925738 DOI: 10.1016/j.ucl.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
This article reviews penile squamous cell carcinoma (PSCC), a rare genitourinary cancer that has been increasing in prevalence. It discusses emerging therapies, focusing on immunotherapy, vaccine therapy, and cell-based treatments, especially in the context of human papillomavirus-related PSCC. Factors influencing these therapies are discussed. These include the immune microenvironment, programmed cell death ligand-1 expression, and tumor immune cell infiltration. This article also highlights immune checkpoint inhibitors and related clinical trials. This review supports the use of personalized medicine in treating PSCC. It stresses the need for collaborative studies and data sharing to create specific treatment plans and achieve better outcomes.
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Affiliation(s)
- Majd Al Assaad
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, 413 East 69th Street, Belfer Research Building, New York, NY 10021, USA.
| | - Houssein Safa
- Department of Hematology/Oncology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Chiara Mercinelli
- Department of Medical Oncology, IRCCS San Raffaele Hospital; Medical Oncology Unit 2, Azienda Ospedaliero-Universitaria Pisana, Via Olgettina 60, Milan 20132, Italy
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive office 12538, Tampa, FL 33612, USA
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS San Raffaele Hospital; Vita-Salute San Raffaele University, Via Olgettina 60, Milan 20132, Italy
| | - Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive office 12538, Tampa, FL 33612, USA.
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García-Perdomo HA, Granados-Duque V, Spiess PE. What is the relationship between penile cancer and the microbiome? A scoping review. Actas Urol Esp 2024:S2173-5786(24)00061-1. [PMID: 38734067 DOI: 10.1016/j.acuroe.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/17/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION The microbiota is defined as the microorganisms in a particular environment. Conversely, the term microbiome is less firmly defined and is used to reference the habitat. OBJECTIVE To identify the association between the microbiome and the penile cancer EVIDENCE ACQUISITION: We performed this scoping review according to the recommendations of the Joanna Briggs Institute. We found five articles that fulfilled the inclusion criteria. We focused on oncogenesis and factors that alter the penile microbiome. We were not limited to language or setting. We searched MEDLINE (Ovid), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and LILACS from inception to the present day. EVIDENCE SYNTHESIS We found nine studies describing multiple factors that could disturb the microbiome, such as sexual behavior, anatomic alterations including circumcision, and inflammatory factors: lichen sclerosus, poor genital hygiene, compromised immune system, smoking, and HPV infection. CONCLUSION Overall, knowledge of the composition of the penile microbiota and its role in penile cancer oncogenesis is minimal. PATIENT SUMMARY Future studies should focus on the relationship between the microbiome and penile cancer to broaden this field of knowledge.
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Affiliation(s)
- H A García-Perdomo
- UROGIV Research Group, Universidad del Valle, Cali, Colombia; Division of Urology/Urooncology, Department of Surgery, School of Medicine, Universidad del Valle, Cali, Colombia.
| | - V Granados-Duque
- UROGIV Research Group, Universidad del Valle, Cali, Colombia; Hospital Universitario del Valle, Cali, Colombia
| | - P E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, Estados Unidos; Department of Genitourinary Oncology and Cancer Biology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States; Urology and Oncology, University of South Florida, Tampa, FL, United States
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Hrudka J, Hojný J, Prouzová Z, Kendall Bártů M, Čapka D, Zavillová N, Matěj R, Waldauf P. High tumour mutational burden is associated with strong PD-L1 expression, HPV negativity, and worse survival in penile squamous cell carcinoma: an analysis of 165 cases. Pathology 2024; 56:357-366. [PMID: 38161143 DOI: 10.1016/j.pathol.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/26/2023] [Accepted: 10/15/2023] [Indexed: 01/03/2024]
Abstract
Penile squamous cell carcinoma (pSCC) is a rare tumour with a variable prognosis. More prognostic markers linked to mutational signatures and the tumour immune microenvironment are needed. A cohort made up of 165 invasive pSCC was retrospectively analysed using formalin-fixed, paraffin-embedded tumour tissue, focusing on tumour mutational burden (TMB), programmed death ligand 1 (PD-L1) expression, microsatellite instability (MSI), the number of tumour infiltrating lymphocytes (TILs) expressing cytotoxic T-lymphocyte-associated protein 4 (CTLA4), HPV status determined by p16 immunohistochemistry, and several traditional histopathological variables. High TMB (>10 mut/Mb) was associated with high PD-L1 expression (TPS 50-100%), and HPV-negative status. High PD-L1 expression was linked to HPV negativity, a high number of intratumoural CTLA4+ cells, and brisk lymphocytic infiltrate. High TMB was a significant predictor of shorter overall survival (OS) in both univariate and multivariate analysis when using a median cut-off value of 4.3 mut/Mb, but not when using an arbitrary cut-off of 10 mut/Mb. Low CTLA4+ cell infiltration at the tumour invasion front was a marker of shorter OS and cancer-specific survival in both univariate and multivariate analysis. PD-L1 expression had no significant impact on prognosis. Only two cases were MSI high. The results support the hypothesis of two aetiological pathways in pSCC cancerogenesis: (1) SCC linked to HPV infection characterised by low TMB, less common PD-L1 expression, and a lower number of TILs; and (2) SCC linked to chronic inflammation leading to a high number of acquired mutations (high TMB), HPV negativity, increased neoantigen production (i.e., PD-L1), and high immune cell infiltration.
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Affiliation(s)
- Jan Hrudka
- Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Jan Hojný
- Department of Pathology, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Zuzana Prouzová
- Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic; Department of Pathology, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Michaela Kendall Bártů
- Department of Pathology, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - David Čapka
- Department of Urology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Nicolette Zavillová
- Department of Urology, 3rd Faculty of Medicine of Charles University, Thomayer University Hospital, Prague, Czech Republic
| | - Radoslav Matěj
- Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic; Department of Pathology, 1st Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic; Department of Pathology and Molecular Medicine, 3rd Faculty of Medicine, Charles University, Thomayer University Hospital, Prague, Czech Republic
| | - Petr Waldauf
- Department of Anaesthesia and Intensive Care Medicine, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Safa H, Mercinelli C, Spiess PE, Necchi A, Chahoud J. Insights into the management of penile squamous cell carcinoma: from conventional approaches to emerging novel therapies. Expert Opin Pharmacother 2024; 25:447-465. [PMID: 38549550 DOI: 10.1080/14656566.2024.2337244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Penile squamous cell carcinoma (PSCC), a rare genitourinary cancer, is associated with poor outcomes due to limited treatment effectiveness, especially in advanced stages. AREAS COVERED While chemotherapy and/or surgery remain the standard of care, emerging therapies like immunotherapy, targeted therapy, and human papillomavirus (HPV) directed therapies show promise. Key to advancing treatment is understanding the immune microenvironment to gain insights into tumor resistance mechanisms and potential therapeutic targets. The scarcity of data on PSCC is a major obstacle in advancing research for this rare cancer. EXPERT OPINION Future research should prioritize collaborative efforts across various research centers and countries. Enhancing data sharing and pooling resources can lead to a more comprehensive understanding of PSCC, ultimately supporting the development of precision medicine strategies tailored to this specific cancer type. This collaborative approach is essential for making significant strides in PSCC treatment and care.
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Affiliation(s)
- Houssein Safa
- Department of Hematology/Oncology, Baylor College of Medicine, Houston, TX, USA
| | - Chiara Mercinelli
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Andrea Necchi
- Department of Medical Oncology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | - Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
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Noronha V, Kapu V, Joshi A, Menon N, Singh A, Prakash G, Menon S, Sable N, Murthy V, Pal M, Arora A, Kumar S, Banavali S, Prabhash K. Clinical Profile and Outcomes of Carcinoma Penis Patients Receiving Systemic Therapy at an Indian tertiary care Center: A Retrospective Observational Study. Clin Genitourin Cancer 2024; 22:102053. [PMID: 38442451 DOI: 10.1016/j.clgc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/03/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Penile cancer is a rare malignancy with scant data on the impact of systemic therapy on outcomes. METHODS Retrospective observational study of patients with a histological diagnosis of carcinoma penis treated with systemic therapy at the Tata Memorial Centre (Mumbai, India) between August 2010 and February 2018. Primary objective was overall survival (OS); secondary objectives included assessment of clinical characteristics, treatment approaches, and toxicity profiles. RESULTS We included 91 patients with penile carcinoma who received systemic therapy at our center. Intent of therapy was curative in 71 patients (78%), and palliative in 20 (22%). Median age was 57 years (interquartile range [IQR], 50-65.5) for curatively treated patients and 58.5 years (IQR, 44-65.2) for those with advanced disease. Common presenting symptoms were lumps (70%), and pain (57%). Neoadjuvant chemotherapy (NACT) with paclitaxel + platinum was administered to 19 patients (20.9%), of which 7 (37%) attained complete or partial response. Six patients (31.5%) underwent R0 surgery post-NACT. All 71 patients underwent primary surgery; 47 (66.2%) undergoing partial penectomy. Of the 20 patients treated with palliative first-line chemotherapy, 4(20%) attained a partial response. Median OS of patients treated in curative and palliative settings was 33.8 months (95% CI, 17.2-not recorded) and 11.4 months (95% CI, 9.53-23.3), respectively. CONCLUSIONS Patients with penile cancer treated with systemic therapy have poor outcomes. Little over a third of the patients respond to neoadjuvant chemotherapy and those with advanced disease have poor survival despite systemic therapy, emphasizing the need for early detection and optimum management of primary and nodal disease.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Venkatesh Kapu
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Ajaykumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Gagan Prakash
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Nilesh Sable
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Mahendra Pal
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Amandeep Arora
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Sravan Kumar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumai, Maharashtra, India.
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Zhang J, Wang Y, Huang Y, Tan X, Xu J, Yan Q, Tan J, Zhang Y, Zhang J, Ma Q, Zhu H, Ye J, Zhu Z, Lan W. Characterization of T cell receptor repertoire in penile cancer. Cancer Immunol Immunother 2024; 73:24. [PMID: 38280010 PMCID: PMC10822009 DOI: 10.1007/s00262-023-03615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/04/2023] [Indexed: 01/29/2024]
Abstract
Tumor-infiltrating lymphocytes (TILs) play a key role in regulating the host immune response and shaping tumor microenvironment. It has been previously shown that T cell infiltration in penile tumors was associated with clinical outcomes. However, few studies have reported the T cell receptor (TCR) repertoire in patients with penile cancer. In the present study, we evaluated the TCR repertoires in tumor and adjacent normal tissues from 22 patients with penile squamous cell carcinoma (PSCC). Analysis of the T cell receptor beta-variable (TRBV) and joining (TRBJ) genes usage and analysis of complementarity determining region 3 (CDR3) length distribution did not show significant differences between tumor and matched normal tissues. Moreover, analysis of the median Jaccard index indicated a limited overlap of TCR repertoire between these groups. Compared with normal tissues, a significantly lower diversity and higher clonality of TCR repertoire was observed in tumor samples, which was associated with clinical characteristics. Further analysis of transcriptional profiles demonstrated that tumor samples with high clonality showed increased expression of genes associated with CD8 + T cells. In addition, we analyzed the TCR repertoire of CD4 + T cells and CD8 + T cells isolated from tumor tissues. We identified that expanded clonotypes were predominantly in the CD8 + T cell compartment, which presented with an exhausted phenotype. Overall, we comprehensively compared TCR repertoire between penile tumor and normal tissues and demonstrated the presence of distinct T cell immune microenvironments in patients with PSCC.
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Affiliation(s)
- Junying Zhang
- Chongqing Key Laboratory of High Active Traditional Chinese Drug Delivery System, Chongqing Engineering Research Center of Pharmaceutical Sciences, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, People's Republic of China
- College of Pharmacy, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Yapeng Wang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Yiqiang Huang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Xintao Tan
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Jing Xu
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Qian Yan
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Jiao Tan
- School of Pharmacy, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, People's Republic of China
| | - Yao Zhang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Jun Zhang
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Qiang Ma
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Hailin Zhu
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China
| | - Jin Ye
- Urinary Nephropathy Center, The Thirteenth People's Hospital of Chongqing, Chongqing, 400053, People's Republic of China.
| | - Zhaojing Zhu
- Chongqing Key Laboratory of High Active Traditional Chinese Drug Delivery System, Chongqing Engineering Research Center of Pharmaceutical Sciences, Chongqing Medical and Pharmaceutical College, Chongqing, 401331, People's Republic of China.
| | - Weihua Lan
- Department of Urology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China.
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Nazha B, Zhuang T, Wu S, Brown JT, Magee D, Carthon BC, Kucuk O, Nabhan C, Barata PC, Heath EI, Ryan CJ, McKay RR, Master VA, Bilen MA. Comprehensive genomic profiling of penile squamous cell carcinoma and the impact of human papillomavirus status on immune-checkpoint inhibitor-related biomarkers. Cancer 2023; 129:3884-3893. [PMID: 37565840 DOI: 10.1002/cncr.34982] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Advanced penile squamous cell carcinoma (pSCC) is a rare and aggressive malignancy with limited success of immune-checkpoint inhibitors (ICIs). Approximately half of pSCC cases are associated with human papillomavirus (HPV) infection. METHODS Evaluation was done retrospectively of the landscape of somatic alterations and ICI-related biomarkers in pSCC by using the Caris Life Sciences data set with the aim to establish signatures for HPV-dependent oncogenesis. The pSCC tumors were analyzed by using next-generation sequencing (NGS) of DNA and RNA. Programmed death ligand 1 (PD-L1) expression was evaluated by immunohistochemistry (IHC). Microsatellite instability (MSI) was tested by fragment analysis, IHC (SP142; ≥1%), and NGS. Tumor mutational burden (TMB)-high was defined as ≥10 mutations/Mb. HPV16/18 status was determined by using whole-exome sequencing (WES) when available. Significance was adjusted for multiple comparisons (q value < .05). RESULTS NGS of the overall cohort (N = 108) revealed TP53 (46%), CDKN2A (26%), and PIK3CA (25%) to be the most common mutations. Overall, 51% of tumors were PD-L1+, 10.7% had high TMB, and 1.1% had mismatch repair-deficient (dMMR)/MSI-high status. Twenty-nine patients had their HPV status made available by WES (HPV16/18+, n = 13; HPV16/18-, n = 16). KMT2C mutations (33% vs. 0%) and FGF3 amplifications (30.8% vs. 0%) were specific to HPV16/18+ tumors, whereas CDKN2A mutations (0% vs. 37.5%) were exclusive to HPV16/18- tumors. TMB-high was exclusively found in the HPV16/18+ group (30.8%). The two groups had comparable PD-L1 and dMMR/MSI-H status. CONCLUSIONS In a large and comprehensive NGS-based evaluation of somatic alterations in pSCC, HPV16/18+ versus HPV16/18- pSCCs were molecularly distinct tumors. Our finding that TMB-high is exclusive to HPV16/18+ tumors requires confirmation in larger data sets. PLAIN LANGUAGE SUMMARY Penile squamous cell carcinoma (pSCC) is a rare and aggressive malignancy in the advanced setting, with poor prognosis and little success with immune-checkpoint inhibitors (ICIs) in an unselected patient approach. Human papillomavirus (HPV) infection is a known risk factor for pSCC; its impact on genomic tumor profiling is less defined. Using next-generation sequencing, we explored the genetic landscape and ICI-related biomarkers of pSCC and HPV-driven oncogenic molecular signatures. Our results indicate that HPV-positive and HPV-negative pSCCs are molecularly distinct tumors. Increased tumor mutational burden is associated with HPV-positive tumors, and could serve as a biomarker for predicting therapeutic response to ICI-based therapies. Our results support the growing literature indicating that HPV status in pSCC can be used to guide patient stratification in ICI-based clinical trials.
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Affiliation(s)
- Bassel Nazha
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Tony Zhuang
- Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Sharon Wu
- Caris Life Sciences, Phoenix, Arizona, USA
| | - Jacqueline T Brown
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Bradley C Carthon
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Omer Kucuk
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Pedro C Barata
- University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | | | - Charles J Ryan
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rana R McKay
- Department of Hematology and Medical Oncology, University of California San Diego, La Jolla, California, USA
| | - Viraj A Master
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Urology, Emory University, Atlanta, Georgia, USA
| | - Mehmet Asim Bilen
- Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
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9
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El Zarif T, Nassar AH, Pond GR, Zhuang TZ, Master V, Nazha B, Niglio S, Simon N, Hahn AW, Pettaway CA, Tu SM, Abdel-Wahab N, Velev M, Flippot R, Buti S, Maruzzo M, Mittra A, Gheeya J, Yang Y, Rodriguez PA, Castellano D, de Velasco G, Roviello G, Antonuzzo L, McKay RR, Vincenzi B, Cortellini A, Hui G, Drakaki A, Glover M, Khaki AR, El-Am E, Adra N, Mouhieddine TH, Patel V, Piedra A, Gernone A, Davis NB, Matthews H, Harrison MR, Kanesvaran R, Giudice GC, Barata P, Farolfi A, Lee JL, Milowsky MI, Stahlfeld C, Appleman L, Kim JW, Freeman D, Choueiri TK, Spiess PE, Necchi A, Apolo AB, Sonpavde GP. Safety and efficacy of immune checkpoint inhibitors in advanced penile cancer: report from the Global Society of Rare Genitourinary Tumors. J Natl Cancer Inst 2023; 115:1605-1615. [PMID: 37563779 PMCID: PMC11032703 DOI: 10.1093/jnci/djad155] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Treatment options for penile squamous cell carcinoma are limited. We sought to investigate clinical outcomes and safety profiles of patients with penile squamous cell carcinoma receiving immune checkpoint inhibitors. METHODS This retrospective study included patients with locally advanced or metastatic penile squamous cell carcinoma receiving immune checkpoint inhibitors between 2015 and 2022 across 24 centers in the United States, Europe, and Asia. Overall survival and progression-free survival were estimated using the Kaplan-Meier method. Objective response rates were determined per Response Evaluation Criteria in Solid Tumours 1.1 criteria. Treatment-related adverse events were graded per the Common Terminology Criteria for Adverse Events, version 5.0. Two-sided statistical tests were used for comparisons. RESULTS Among 92 patients, 8 (8.7%) were Asian, 6 (6.5%) were Black, and 24 (29%) were Hispanic and/or Latinx. Median (interquartile range) age was 62 (53-70) years. In all, 83 (90%) had metastatic penile squamous cell carcinoma, and 74 (80%) had received at least second-line treatment. Most patients received pembrolizumab monotherapy (n = 26 [28%]), combination nivolumab-ipilimumab with or without multitargeted tyrosine kinase inhibitors (n = 23 [25%]), or nivolumab (n = 16 [17%]) or cemiplimab (n = 15 [16%]) monotherapies. Median overall and progression-free survival were 9.8 months (95% confidence interval = 7.7 to 12.8 months) and 3.2 months (95% confidence interval = 2.5 to 4.2 months), respectively. The objective response rate was 13% (n = 11/85) in the overall cohort and 35% (n = 7/20) in patients with lymph node-only metastases. Visceral metastases, Eastern Cooperative Oncology Group (ECOG) performance status of 1 or higher, and a higher neutrophil/lymphocyte ratio were associated with worse overall survival. Treatment-related adverse events occurred in 27 (29%) patients, and 9.8% (n = 9) of the events were grade 3 or higher. CONCLUSIONS Immune checkpoint inhibitors are active in a subset of patients with penile squamous cell carcinoma. Future translational studies are warranted to identify patients more likely to derive clinical benefit from immune checkpoint inhibitors.
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Affiliation(s)
- Talal El Zarif
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Amin H Nassar
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Gregory R Pond
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Tony Zibo Zhuang
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Viraj Master
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Bassel Nazha
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Scot Niglio
- New York University Grossman School of Medicine, New York, NY, USA
| | - Nicholas Simon
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrew W Hahn
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Shi-Ming Tu
- Division of Hematology and Oncology, University of Arkansas for Medical Sciences, Winthrop P. Rockefeller Cancer Institute, Little Rock, AR, USA
| | - Noha Abdel-Wahab
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Assiut University Faculty of Medicine, Assiut University Hospitals, Assiut, Egypt
| | - Maud Velev
- Département d’Innovation Thérapeutique et Essais Précoces, Gustave Roussy—Paris-Saclay University, Villejuif, France
| | - Ronan Flippot
- Medical Oncology Department, Institute Gustave Roussy, Villejuif, France
| | - Sebastiano Buti
- Department of Medicine and Surgery, Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Marco Maruzzo
- Oncology 1 Unit, Istituto Oncologico Veneto IOV—Istituto Di Ricovero e Cura a Carattere Scientifico, Padova, Italy
| | - Arjun Mittra
- Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Jinesh Gheeya
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center—James Cancer Hospital, Columbus, OH, USA
| | - Yuanquan Yang
- Genitourinary Oncology Section, Division of Medical Oncology, The Ohio State University Comprehensive Cancer Center—James Cancer Hospital, Columbus, OH, USA
| | | | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Guillermo de Velasco
- Department of Medical Oncology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Giandomenico Roviello
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rana R McKay
- University of California San Diego, San Diego, CA, USA
| | - Bruno Vincenzi
- Medical Oncology Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Alessio Cortellini
- Medical Oncology Department, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Department of Surgery and Cancer, Hammersmith Hospital Campus, Imperial College London, London, United Kingdom
| | - Gavin Hui
- University of California Los Angeles, Los Angeles, CA, USA
| | | | - Michael Glover
- Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Ali Raza Khaki
- Division of Medical Oncology, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nabil Adra
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Tarek H Mouhieddine
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vaibhav Patel
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Aida Piedra
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Nancy B Davis
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harrison Matthews
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
| | - Michael R Harrison
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA
| | | | - Giulia Claire Giudice
- Department of Medicine and Surgery, Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Pedro Barata
- University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Alberto Farolfi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori “Dino Amadori,” Meldola, Italy
| | - Jae Lyun Lee
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Matthew I Milowsky
- University of North Carolina, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Charlotte Stahlfeld
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Leonard Appleman
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Joseph W Kim
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Dory Freeman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Toni K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Andrea Necchi
- Department of Genitourinary Oncology, Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea B Apolo
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Guru P Sonpavde
- Division of Medical Oncology, Advent Health Cancer Institute, Orlando, FL, USA
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10
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Tekin B, Cheville JC, Herrera Hernandez L, Negron V, Smith CY, Jenkins SM, Dasari S, Enninga EAL, Norgan AP, Menon S, Cubilla AL, Whaley RD, Jimenez RE, Thompson RH, Leibovich BC, Karnes RJ, Boorjian SA, Pagliaro LC, Erickson LA, Guo R, Gupta S. Assessment of PD-L1, TROP2, and nectin-4 expression in penile squamous cell carcinoma. Hum Pathol 2023; 142:42-50. [PMID: 37977513 DOI: 10.1016/j.humpath.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES There is an unmet need for therapeutically relevant biomarkers for advanced penile squamous cell carcinoma (pSCC). Proposed immunohistochemistry (IHC)-based biomarkers include programmed death-ligand 1 (PD-L1), trophoblast cell-surface antigen 2 (TROP2), and nectin-4; however, there is a paucity of data pertaining to these biomarkers. Herein, we investigated the expression of PD-L1, TROP2, and nectin-4 in a well-annotated cohort of pSCCs. METHODS A single-institution pathology archive was queried for patients who had a partial or total penectomy for pSCC between January 2000 and December 2022. Whole-slide sections were stained with antibodies against PD-L1 (22C3), TROP2, and nectin-4. Expression in tumor cells was quantified using H-scores (0-300). Associations between IHC expression, human papilloma virus (HPV) status, clinicopathologic findings, and outcome parameters were evaluated. RESULTS This study included 121 patients. For PD-L1, the median combined positive and H-scores were 1 and 0, respectively; 32.7 % of the cases had an H-score>0. Compared to PD-L1-negative tumors, PD-L1-positive tumors had higher pT stage and grade. The median TROP2 and nectin-4 H-scores were 230 and 140, respectively, with high TROP2 and nectin-4, defined by an H-score>200, noted in 80.7 % and 10.9 % of cases, respectively. High-risk HPV-positive cases had higher TROP2 and nectin-4 scores compared to HPV-negative cases. Patients with high TROP2 expression had significantly more disease progression, and patients with high nectin-4 expression had significantly fewer deaths due to disease. CONCLUSIONS High expression of TROP2 and nectin-4 in pSCC support evaluation of these markers as therapeutic targets pending validation of our findings.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | - Vivian Negron
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Carin Y Smith
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
| | - Surendra Dasari
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | | | - Andrew P Norgan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Santosh Menon
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - Antonio L Cubilla
- Instituto de Patología e Investigación, Universidad Nacional de Asunción, Asunción, Paraguay.
| | - Rumeal D Whaley
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Rafael E Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | | - Lance C Pagliaro
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN, USA.
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Ruifeng Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Sounak Gupta
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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11
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Wei L, Huang K, Han H, Liu RY. Human Papillomavirus Infection in Penile Cancer: Multidimensional Mechanisms and Vaccine Strategies. Int J Mol Sci 2023; 24:16808. [PMID: 38069131 PMCID: PMC10706305 DOI: 10.3390/ijms242316808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/19/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
Penile cancer (PC) is a rare male malignant tumor, with early lymph node metastasis and poor prognosis. Human papillomavirus (HPV) plays a key role in the carcinogenesis of PC. This review aims to summarize the association between HPV infection and PC in terms of virus-host genome integration patterns (the disrupted regions in the HPV and PC genome), genetic alterations, and epigenetic regulation (methylation and microRNA modification) occurring in HPV and PC DNA, as well as tumor immune microenvironment reprogramming. In addition, the potential of HPV vaccination strategies for PC prevention and treatment is discussed. Understanding of the HPV-related multidimensional mechanisms and the application of HPV vaccines will promote rational and novel management of PC.
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Affiliation(s)
- Lichao Wei
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (L.W.); (K.H.)
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Kangbo Huang
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (L.W.); (K.H.)
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hui Han
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (L.W.); (K.H.)
- Department of Urology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ran-yi Liu
- State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou 510060, China; (L.W.); (K.H.)
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12
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Rouvinov K, Mazor G, Kozlener E, Meirovitz A, Shrem NS, Abu Saleh O, Shalata S, Yakobson A, Shalata W. Cemiplimab as First Line Therapy in Advanced Penile Squamous Cell Carcinoma: A Real-World Experience. J Pers Med 2023; 13:1623. [PMID: 38003938 PMCID: PMC10672594 DOI: 10.3390/jpm13111623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
In the treatment of cancer, immune checkpoint inhibitors (ICIs) have demonstrated significantly greater effectiveness compared to conventional cytotoxic or platinum-based chemotherapies. To assess the efficacy of ICI's in penile squamous cell carcinoma (pSCC) we performed a retrospective observational study. We reviewed electronic medical records of patients with penile squamous cell carcinoma (SCC), diagnosed between January 2020 and February 2023. Nine patients were screened, of whom three were ineligible for chemotherapy and received immunotherapy, cemiplimab, in a first-line setting. Each of the three immunotherapy-treated patients achieved almost a complete response (CR) after only a few cycles of therapy. The first patient had cerebral arteritis during treatment and received a high-dose steroid treatment with resolution of the symptoms of arteritis. After tapering down the steroids dose, the patient continued cemiplimab without further toxicity. The other two patients did not have any toxic side effects of the treatment. To the best of our knowledge, this is the first real world report of near CR with cemiplimab as a first-line treatment in penile SCC.
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Affiliation(s)
- Keren Rouvinov
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center and Ben Gurion University, Beer Sheva 84105, Israel
| | - Gal Mazor
- Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - Ella Kozlener
- Department of Oncology, Bnei Zion Medical Center, Haifa 31048, Israel
| | - Amichay Meirovitz
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center and Ben Gurion University, Beer Sheva 84105, Israel
| | - Noa Shani Shrem
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center and Ben Gurion University, Beer Sheva 84105, Israel
| | - Omar Abu Saleh
- Department of Dermatology and Venereology, Emek Medical Centre, Afula 18341, Israel
| | - Sondos Shalata
- Nutrition Unit, Galilee Medical Center, Nahariya 22000, Israel
| | - Alexander Yakobson
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center and Ben Gurion University, Beer Sheva 84105, Israel
| | - Walid Shalata
- The Legacy Heritage Center & Dr. Larry Norton Institute, Soroka Medical Center and Ben Gurion University, Beer Sheva 84105, Israel
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13
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de Vries HM, Rafael TS, Gil-Jimenez A, de Feijter JM, Bekers E, van der Laan E, Lopez-Yurda M, Hooijberg E, Broeks A, Peters D, Seignette IM, Pos FJ, Horenblas S, van Rhijn BWG, Jordanova ES, Brouwer OR, Schaake E, van der Heijden MS. Atezolizumab With or Without Radiotherapy for Advanced Squamous Cell Carcinoma of the Penis (The PERICLES Study): A Phase II Trial. J Clin Oncol 2023; 41:4872-4880. [PMID: 37487169 DOI: 10.1200/jco.22.02894] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/23/2023] [Accepted: 06/13/2023] [Indexed: 07/26/2023] Open
Abstract
PURPOSE Patients with advanced penile squamous cell carcinoma have a poor prognosis (21% 2-year overall survival [OS] from diagnosis). We assessed the activity of atezolizumab (anti-PD-L1) in patients with advanced penile cancer, with or without radiotherapy (RT). PATIENTS AND METHODS A single-center, nonrandomized phase II study with two treatment arms was conducted in 32 patients with histologically confirmed advanced penile cancer. All patients received atezolizumab (1,200 mg) once every 3 weeks. Twenty patients, who were expected to benefit from RT for locoregional disease control, received additional irradiation. The primary end point was 1-year progression-free survival (PFS) for the complete cohort and was reached if the actual 1-year PFS was at least 35%. Secondary end points included OS, objective response rate (ORR), and tolerability. Exploratory biomarker analyses were conducted in pretreatment specimens. RESULTS Median follow-up was 29.1 months (IQR, 18.1-33.5). Grade 3-4 adverse events related to atezolizumab or RT were observed in 3/32 (9.4%) and 13/20 (65%) patients, respectively. One-year PFS was 12.5% (95% CI, 5.0 to 31.3), which did not meet the study's primary end point. Median OS was 11.3 months (95% CI, 5.5 to 18.7). In the objective response-evaluable population (n = 30; 93.8%), the ORR was 16.7% (95% CI, 6 to 35), including 2 (6.7%) complete responders and 3 (10%) partial responders. Improved PFS was observed in patients with high-risk human papillomavirus (hrHPV)-positive tumors (P = .003) and those with high infiltration of intratumoral CD3+CD8+ T cells (P = .037). CONCLUSION Although the primary end point of 1-year PFS was not met, durable antitumor activity to atezolizumab was observed in a subset of patients. Biomarkers, such as hrHPV and intratumoral CD3+CD8+ T-cell infiltration, may help to better select responders.
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Affiliation(s)
- Hielke M de Vries
- Department of Internal Medicine, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Tynisha S Rafael
- Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Alberto Gil-Jimenez
- Department of Internal Medicine, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Molecular Carcinogenesis, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Jeantine M de Feijter
- Department of Internal Medicine, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Elise Bekers
- Department of Pathology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Elsbeth van der Laan
- Department of Internal Medicine, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Marta Lopez-Yurda
- Department of Biostatistics, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Erik Hooijberg
- Department of Pathology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Annegien Broeks
- Core Facility Molecular Pathology and Biobanking, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Dennis Peters
- Core Facility Molecular Pathology and Biobanking, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Iris M Seignette
- Department of Pathology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Floris J Pos
- Department of Radiation Therapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Simon Horenblas
- Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Bas W G van Rhijn
- Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Ekaterina S Jordanova
- Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Oscar R Brouwer
- Department of Urology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Eva Schaake
- Department of Radiation Therapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Michiel S van der Heijden
- Department of Internal Medicine, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
- Department of Molecular Carcinogenesis, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
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14
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Sangkhamanon S, Kotano N, Sirithanaphol W, Rompsaithong U, Kiatsopit P, Sookprasert A, Wirasorn K, Twinprai P, Watcharenwong P, Chindaprasirt J. Programmed death‑ligand 1 expression in tumor cells and tumor‑infiltrating lymphocytes are associated with depth of tumor invasion in penile cancer. Biomed Rep 2023; 19:44. [PMID: 37324166 PMCID: PMC10265570 DOI: 10.3892/br.2023.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/25/2023] [Indexed: 06/17/2023] Open
Abstract
The present study aimed to demonstrate the proportion of the programmed death-ligand 1 (PD-L1) expression in penile cancer patients and the association with clinicopathological parameters. Formalin-fixed paraffin-embedded specimens were obtained from 43 patients with primary penile squamous cell carcinoma treated at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, between 2008 and 2018. PD-L1 expression was evaluated by the immunohistochemistry using an SP263 monoclonal antibody. PD-L1 positivity was defined as >25% tumor cell staining or >25% tumor-associated immune cell staining. The correlation between PD-L1 expression and clinicopathological parameters was analyzed. A total of eight of 43 patients (18.6%) were identified as positive for PD-L1 expression in tumor cells and tumor-infiltrating lymphocytes. In the PD-L1 positive group, there was a significant association with pathological T stage (P=0.014) with a higher percentage of PD-L1 positive tumors in T1 stage compared with T2-T4 stage. In this cohort, there was a trend towards longer survival in patients with positive PD-L1 expression (5-year OS: 75% vs. 61.2%, P=0.19). Lymph node involvement and the location of tumor at the shaft of penis were two independent prognostic factors for survival. In conclusion, the PD-L1 expression was detected in 18% of penile cancer patients and high expression of PD-L1 was associated with the early T stage.
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Affiliation(s)
- Sakkarn Sangkhamanon
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Natcha Kotano
- Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Wichien Sirithanaphol
- Division of Urologic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Ukrit Rompsaithong
- Division of Urologic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Pakorn Kiatsopit
- Division of Urologic Surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Aumkhae Sookprasert
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kosin Wirasorn
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Prin Twinprai
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Piyakarn Watcharenwong
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Jarin Chindaprasirt
- Division of Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
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15
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Naushad N, Deb AA, Agag AA, Serag HA, Sangar VK. Prognostic Markers and Trials in Penile Cancer. UROLOGY RESEARCH & PRACTICE 2023; 49:138-146. [PMID: 37877863 PMCID: PMC10346112 DOI: 10.5152/tud.2023.22225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/03/2023] [Indexed: 10/26/2023]
Abstract
New tumor biomarkers open the potential for designing personalized therapy for penile squamous cell carcinoma. Despite the initial promising results of some biomarkers, controversy remains due to contradictory studies. Further robust research work is required before incorporating biomarkers in the personalized management of penile cancer. This narrative review aims to highlight some of the most commonly and recently investigated biomarkers of penile cancer and to summarize the ongoing registered clinical trials for the management of penile cancer patients.
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Affiliation(s)
- Naufal Naushad
- Department of Urology, Christie NHS Foundation Trust, Manchester, UK
| | - Abdalla A. Deb
- Department of Urology, James Cook University Hospital, Middlesbrough, UK
| | - Ayman A. Agag
- Department of Urology, Frimley Park Hospital, Frimley, UK
| | - Hosam A. Serag
- Department of Urology, University Hospitals Birmingham, Birmingham, UK
| | - Vijay K. Sangar
- Department of Urology, Christie NHS Foundation Trust, Manchester, UK
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16
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The Evolving Landscape of Viral, Immune, and Molecular Biomarkers in Penile Cancer. Urol Clin North Am 2023; 50:145-150. [DOI: 10.1016/j.ucl.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Chen HX, Lin CC, Lin CH, Yang CR. Combination of Durvalumab and Chemotherapy to Potentially Convert Unresectable Stage IV Penile Squamous Cell Carcinoma to Resectable Disease: A Case Report. Curr Oncol 2022; 30:326-332. [PMID: 36661675 PMCID: PMC9857427 DOI: 10.3390/curroncol30010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Penile squamous cell carcinoma is a rare disease entity with poor overall survival in an advanced stage. Few studies have investigated the role of immunotherapy in advanced penile squamous cell carcinoma. Herein, we report a case of stage IV unresectable penile squamous cell carcinoma presenting with anal bleeding and urethra obstruction who responded dramatically to combination therapy of durvalumab and cisplatin-based chemotherapy. The patient had HPV-positive penile squamous cell carcinoma, cT3N3M0, with concomitant anus squamous cell carcinoma. After 2 months of the combination treatment, almost all bulky inguinal lymph nodes shrank, and the main tumor of the anus and penis responded completely. A durable response was seen 16 months after initiating the combination therapy. This case report highlights the potential role of the combination of immunotherapy and chemotherapy in patients with advanced penile cancer. The promising results of this combination resulted in the conversion of unresectable disease to a potentially curable disease.
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Affiliation(s)
- Hao Xiang Chen
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
| | - Ching-Chan Lin
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan 709, Taiwan
| | - Che-Hung Lin
- Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, China Medical University, Taichung 404, Taiwan
| | - Chi-Rei Yang
- Department of Urology, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
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18
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Lu Y, Wang Y, Su H, Li H. PD-L1 is associated with the prognosis of penile cancer: A systematic review and meta-analysis. Front Oncol 2022; 12:1013806. [PMID: 36530970 PMCID: PMC9748474 DOI: 10.3389/fonc.2022.1013806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Previous studies have explored the role of PD-L1 in the survival outcomes of penile cancer patients with controversies existed. Thus, the meta-analysis was conducted to report and review the association between PD-L1 and survival in penile cancer patients. METHODS PubMed, Cochrane Library, EMBASE, and Web of Science were all searched, screened, and reviewed by June 1, 2022. Hazard ratio (HR) was used to evaluate the relationship between PD-L1 and survival outcome, and odds ratio (OR) was for tumor features. RESULTS Nine retrospective studies (1,003 patients) were incorporated. The prevalence of PD-L1 in patients with penile cancer was 51.4% (95% CI = 42.1%-60.8%, I 2 = 88.5%). Higher PD-L1 on tumor cells was related to shorter cancer-specific survival (CSS) in patients (HR = 1.578, 95% CI = 1.227-2.029, I 2 = 23.3%), but had no associations with overall survival (OS) (HR = 1.123, 95% CI = 0.511-2.465, I 2 = 0.0%). Subgroup analysis indicated that higher PD-L1 was related to shorter CSS in Caucasus (HR = 1.827, 95% CI = 1.355-2.465, I 2 = 0.0%) only. Furthermore, PD-L1 had associations with tumor stage (pT1 vs. pT2-4, OR = 0.480, 95% CI = 0.346-0.667, P = 0.001) and tumor grade (Well and moderate vs. Poor, OR = 0.377, 95% CI = 0.264-0.538, P < 0.001). PD-L1 positivity was also related to lymph node (LN) status (pN0/NX vs. pN1-3, OR = 0.541, 95% CI = 0.385-0.759, P = 0.001) and HPV status (Positive vs. Negative, OR = 0.510, 95% CI = 0.322-0.810, P = 0.003). A trend toward statistical significance between PD-L1 and histological types was also observed (Usual SCC vs. Others, OR = 1.754, 95% CI = 0.984-3.124, P = 0.070). CONCLUSIONS PD-L1 over-expression was related to worse survival outcomes and several clinicopathological features of penile cancer. PD-L1 expression can be applied to select appropriate treatment strategies for penile malignancies. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343041, identifier CRD42022343041.
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Affiliation(s)
| | | | | | - Hongjun Li
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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19
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Du Y, Zhang X, Zhang Y, Li W, Hu W, Zong L, Zhao J. PD-1 inhibitor treatment in a penile cancer patient with MMR/MSI status heterogeneity: A case report. Hum Vaccin Immunother 2022; 18:2121122. [PMID: 36162043 DOI: 10.1080/21645515.2022.2121122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Penile cancer is a rare malignant disease. Paclitaxel combined with platinum is often used as a first-line chemotherapeutic regimen for late-stage penile cancer, and there is no standard second-line treatment. Clinical trials of immunotherapy for penile cancer are ongoing. There are no reports on PD1 inhibitor treatment in metastatic penile carcinoma patients with MMR/MSI status heterogeneity. A 68-year-old patient was hospitalized with bilateral inguinal lymph node metastasis and local penile recurrence after penile cancer surgery. The lesion of the right inguinal lymph node showed a mismatch-repair-deficient (dMMR)/microsatellite instability-low (MSI-L) status. After 3 cycles of sintilimab (a PD1 inhibitor) combined with paclitaxel and cisplatin, the partial response of the tumor was evaluated. Subsequently, sintilimab monotherapy was used as maintenance treatment for 2 months. However, The lesion of local penile recurrence showed mismatch repair proficient (pMMR)/microsatellite stability (MSS) status by secondary biopsy when progressed rapidly. Interestingly, after continued treatment with sintilimab combined with gemcitabine, the patient achieved a partial response again. We should be aware of the importance of secondary biopsy for different lesions to confirm the heterogeneity of MMR/MSI status. For penile cancer patients with MMR/MSI status heterogeneity, PD1 inhibitors combined with chemotherapy are safe and effective. Due to oligometastatic lesion progression caused only by the heterogeneity of MMR/MSI status, PD1 inhibitor cross-line therapy can also be considered an appropriate treatment.
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Affiliation(s)
- YunYi Du
- Department of Oncology, Changzhi people's Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - XiaoLing Zhang
- Department of Oncology, Changzhi people's Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Ying Zhang
- Department of Oncology, Changzhi people's Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China.,Department of Respiration, Changzhi Medical College, Changzhi, Shanxi, China
| | - WeiLing Li
- Department of Oncology, Changzhi people's Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China.,Department of Respiration, Changzhi Medical College, Changzhi, Shanxi, China
| | - WenQing Hu
- Department of Gastrointestinal Surgery, Changzhi people's Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Liang Zong
- Department of Gastrointestinal Surgery, Changzhi people's Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
| | - Jun Zhao
- Department of Oncology, Changzhi people's Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
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20
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Tang Y, Hu X, Wu K, Li X. Immune landscape and immunotherapy for penile cancer. Front Immunol 2022; 13:1055235. [PMID: 36524123 PMCID: PMC9745054 DOI: 10.3389/fimmu.2022.1055235] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/15/2022] [Indexed: 11/30/2022] Open
Abstract
Penile cancer is a rare malignancy and usually refers to penile squamous cell carcinoma (PSCC), which accounts for more than 95% of all penile malignancies. Although organ-sparing surgery is an effective treatment for early-stage PSCC, surgical intervention alone is often not curative for advanced PSCC with metastases to the inguinal and/or pelvic lymph nodes; thus, systemic therapy is required (usually platinum-based chemotherapy and surgery combined). However, chemotherapy for PSCC has proven to be of limited efficacy and is often accompanied by high toxicity, and patients with advanced PSCC usually have poor prognosis. The limited treatment options and poor prognosis indicate the unmet need for advanced PSCC. Immune-based therapies have been approved for a variety of genitourinary and squamous cell carcinomas but are rarely reported in PSCC. To date, several studies have reported high expression of PDL1 in PSCC, supporting the potential application of immune checkpoint inhibitors in PSCC. In addition, human papillomavirus (HPV) infection is highly prevalent in PSCC and plays a key role in the carcinogenesis of HPV-positive PSCC, suggesting that therapeutic HPV vaccine may also be a potential treatment modality. Moreover, adoptive T cell therapy (ATC) has also shown efficacy in treating advanced penile cancer in some early clinical trials. The development of new therapeutics relies on understanding the underlying biological mechanisms and processes of tumor initiation, progression and metastasis. Therefore, based on the interest, we reviewed the tumor immune microenvironment and the emerging immunotherapy for penile cancer.
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Affiliation(s)
| | | | | | - Xiang Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
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21
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Savoie PH, Murez T, Neuville P, Ferretti L, Rocher L, Van Hove A, Camparo P, Fléchon A, Branger N, Rouprêt M. French AFU Cancer Committee Guidelines - Update 2022-2024: penile cancer. Prog Urol 2022; 32:1010-1039. [PMID: 36400476 DOI: 10.1016/j.purol.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/24/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To update French oncology guidelines concerning penile cancer. METHODS Comprehensive Medline search between 2020 and 2022 upon diagnosis, treatment and follow-up of testicular germ cell cancer to update previous guidelines. Level of evidence was evaluated according to AGREE-II. RESULTS Epidermoid carcinoma is the most common penile cancer histology. Physical examination is mandatory to define local and inguinal nodal cancer stage. MRI with artificial erection can help to assess deep infiltration in cases of organsparing intention. Node negative patients (defined by palpation and imaging) will present micro nodal metastases in up to 25% of cases. Invasive lymph node assessment is thus advocated except for low risk patients. Sentinel node dynamic biopsy is the first line technique. Modified bilateral inguinal lymphadenectomy is an option with higher morbidity. 18-FDG-PET is recommended in patients with palpable nodes. Chest, abdominal and pelvis computerized tomography is an option. Fine needle aspiration (when positive) is an easy way to assess inguinal palpable node pathological involvement. Its results determine the type of lymphadenectomy to be performed (for diagnostic or curative purposes). Treatment is mostly surgical. Free margins status is essential, but it also has to be organ-sparing when possible. Brachytherapy and topic agents can cure in selected cases. Lymph node assessment should be synchronous to the removal of the tumour when possible. Limited inguinal lymph node involvement (pN1 stage) can be cured with the only lymphadenectomy. In case of larger lymph node stage, one should consider multidisciplinary treatment including chemotherapy and inclusion in a trial. CONCLUSIONS Penile cancer needs demanding surgery to be cured, surrounded by chemotherapy in node positive patients. Lymph nodes involvement is a major prognostic factor. Thus, inguinal node assessment cannot be neglected.
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Affiliation(s)
- P H Savoie
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon Cedex 09, France.
| | - T Murez
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier Cedex 5, France
| | - P Neuville
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - L Ferretti
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - L Rocher
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, APHP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Van Hove
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Hôpital Européen, 6, rue Désirée-Clary, 13003 Marseille, France
| | - P Camparo
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - A Fléchon
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - N Branger
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut Paoli-Calmettes, 232, Boulevard Sainte Marguerite, 13273 Marseille, France
| | - M Rouprêt
- Comité de Cancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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22
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Zhu M, Yin H, Dong B, Yang T. Penile cancer with bilateral inguinal lymph node metastases survives more than 4 years: A case report. Asian J Surg 2022; 46:1590-1591. [PMID: 36307266 DOI: 10.1016/j.asjsur.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 12/09/2022] Open
Affiliation(s)
- Mingkai Zhu
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Huaqi Yin
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Bingqi Dong
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Tiejun Yang
- Department of Urology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
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23
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Chadha J, Chahoud J, Spiess PE. An update on treatment of penile cancer. Ther Adv Med Oncol 2022; 14:17588359221127254. [PMID: 36172172 PMCID: PMC9511530 DOI: 10.1177/17588359221127254] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Penile cancer is a rare malignancy, particularly in industrialized nations. In the United States, rates are approximately less than 1 per 100,000 men per year with just over 2000 new cases per year. However, there is significantly increased prevalence in developing nations, with limited treatment expertise and reduced access to care, further driving an unmet clinical need. The most noteworthy risk factor for penile cancer is the association with human papillomavirus infection, which may be present in up to 50% of all penile carcinomas. In addition to local primary tumor approaches, multimodality treatment strategies are vital to patients with clinical regional nodal disease, locally advanced disease. Presence and degree of lymph node involvement remains the most important prognostic factor and patients may benefit from multiple treatment strategies. Interim analysis data from the first randomized clinical trial is expected to yield results in mid/late 2024–early 2025. These treatment approaches include neoadjuvant chemotherapy, adjuvant therapy, including chemotherapy and radiation. Systemic therapy for distant recurrent or metastatic disease is primarily a platinum-based chemotherapy, however with poor overall response. As poor outcomes remain high, particularly in indigent populations, there remains an unmet need for these patients, particularly for high level randomized trials and novel therapeutics. In this review, we will highlight treatment updates for penile cancer. In addition to standard of care, we will review novel lines of therapies including immunotherapies and targeted therapies as well as sequencing approaches.
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Affiliation(s)
- Juskaran Chadha
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 Magnolia Drive, Tampa, FL 33612, USA
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24
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25
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Immunohistochemical expression of PD-L1 and MDR1 in breast tumors: association with clinico-pathological parameters and treatment outcome. Clin Exp Med 2022:10.1007/s10238-022-00852-x. [PMID: 35810258 DOI: 10.1007/s10238-022-00852-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/15/2022] [Indexed: 11/03/2022]
Abstract
Antitumor immune evasion is a hallmark for the development and progression of cancer. Tumor cells adopt various mechanisms to escape the host immune system recognition. One such mechanism is the over expression of programmed death ligand (PD-L1), a negative T cell regulatory molecule. Because PD-L1 overexpression causes resistance to chemotherapeutic response in many cancers, herein we explored the relationship between PD-L1 and multidrug resistance protein MDR1 in breast cancer. Immunohistochemical evaluation of PD-L1 and MDR1 proteins in 194 breast cancer tissue samples were carried out. The relationship between PD-L1 and MDR1 expression on cancer cells with clinicopathological factors and prognosis was investigated. IHC showed a significant correlation between PD-L1 and MDR1 expression on tumor cells. Increased PD-L1 expression was also associated with lymph node status and tumor grade of the patient. Our results also revealed that the expression of PD-L1 and MDR1 was higher in TNBC subtype compared to other breast cancer subtypes. Therefore, a better understanding of the molecular mechanism through which PD-1/PD-L1 pathway contribute to the chemoresistance might bring forth the prognostic significance of PD-L1 and selection of patients who may benefit from immunotherapy.
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26
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Vinueza-Obando D, Spiess PE, García-Perdomo HA. Pembrolizumab as a promising intervention for advanced penile cancer. Int Braz J Urol 2022; 48:719-721. [PMID: 35373954 PMCID: PMC9306374 DOI: 10.1590/s1677-5538.ibju.2022.99.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/20/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Philippe E Spiess
- Department of Genito-Urinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Urology and Oncology, University of South Florida, Tampa, FL, USA
| | - Herney Andrés García-Perdomo
- UROGIV Research Group. School of Medicine. Universidad del Valle. Cali, Colombia.,Division of Urology/Urooncology. Department of Surgery, School of Medicine. Universidad del Valle. Cali, Colombia
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27
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Alencar AM, Sonpavde G. Emerging Therapies in Penile Cancer. Front Oncol 2022; 12:910335. [PMID: 35800050 PMCID: PMC9253417 DOI: 10.3389/fonc.2022.910335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/04/2022] [Indexed: 11/25/2022] Open
Abstract
Advances in the treatment of rare tumors like penile cancer were always hampered by the lack of deep comprehension of the molecular biology and genomic and epigenomic alterations involved in carcinogenesis and tumor progression, as well as by the difficulty in recruitment of patients for prospective clinical trials. Despite the high rates of cure in early localized penile cancers with surgery or other local procedures, locally advanced and metastatic tumors require systemic treatment, with chemotherapy being the current standard, but with high toxicity and no proven real impact on survival. Recent important findings of frequent genomic alterations and mutation signatures in penile cancer have motivated several trials in new modalities of systemic treatments, especially immunotherapy. This review aims to present the most recent advances and the prospect of new modalities of systemic therapies with ongoing studies in penile cancer.
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Affiliation(s)
- Antonio Machado Alencar
- Grupo de Estudos em Patologia Molecular, Hospital Universitário da Universidade Federal do Maranhão, São Luís, Brazil
- Department of Clinical Oncology, Hospital São Domingos/Dasa, São Luís, Brazil
| | - Guru Sonpavde
- Department of Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- *Correspondence: Guru Sonpavde,
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Simultaneous and Spatially-Resolved Analysis of T-Lymphocytes, Macrophages and PD-L1 Immune Checkpoint in Rare Cancers. Cancers (Basel) 2022; 14:cancers14112815. [PMID: 35681797 PMCID: PMC9179863 DOI: 10.3390/cancers14112815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary To study various biomarkers, it is necessary to analyze multiple tissue sections through serial histological sections, which is challenging when only a small tissue sample is available. In this work we have developed a validated and objective method for combined biomarker immunostaining and its digital image analysis using open informatics tools, which is necessary for comprehensive understanding of the tumor microenvironment in rare cancers and in cases of limited samples with very significant clinical features. Abstract Penile, vulvar and anal neoplasms show an incidence lower than 0.5% of the population per year and therefore can be considered as rare cancers but with a dramatic impact on quality of life and survival. This work describes the experience of a Chilean cancer center using multiplexed immunofluorescence to study a case series of four penile cancers, two anal cancers and one vulvar cancer and simultaneous detection of CD8, CD68, PD-L1, Cytokeratin and Ki-67 in FFPE samples. Fluorescent image analyses were performed using open sources for automated tissue segmentation and cell phenotyping. Our results showed an objective and reliable counting of objects with a single or combined labeling or within a specific tissue compartment. The variability was below 10%, and the correlation between analytical events was 0.92–0.97. Critical cell phenotypes, such as TILs, PD-L1+ or proliferative tumor cells were detected in a supervised and unsupervised manner with a limit of detection of less than 1% of relative abundance. Finally, the observed diversity and abundance of the different cell phenotypes within the tumor microenvironment for the three studied tumor types confirmed that our methodology is useful and robust to be applicable for many other solid tumors.
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Montella M, Sabetta R, Ronchi A, De Sio M, Arcaniolo D, De Vita F, Tirino G, Caputo A, D'Antonio A, Fiorentino F, Facchini G, Lauro GD, Perdonà S, Ventriglia J, Aquino G, Feroce F, Borges Dos Reis R, Neder L, Brunelli M, Franco R, Zito Marino F. Immunotherapy in Penile Squamous Cell Carcinoma: Present or Future? Multi-Target Analysis of Programmed Cell Death Ligand 1 Expression and Microsatellite Instability. Front Med (Lausanne) 2022; 9:874213. [PMID: 35592855 PMCID: PMC9113025 DOI: 10.3389/fmed.2022.874213] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Penile cancer (PC) is an extremely rare malignancy, and the patients at advanced stages have currently limited treatment options with disappointing results. Immune checkpoint inhibitors anti-programmed cell death 1 (PD-1)/programmed cell death ligand 1 (PD-L1) are currently changing the treatment of several tumors. Furthermore, the microsatellite instability (MSI) and the deficient mismatch repair system (dMMR) proteins represent predictive biomarkers for response to immune checkpoint therapy. Until present, few data have been reported related to PD-L1 expression and MSI in PC. The main aim of our study was the evaluation of PD-L1 expression in tumor cells (TCs) and tumor-infiltrating lymphocytes (TILs) in immune cells and the analysis of dMMR/MSI status in a large series of PCs. Methods A series of 72 PC, including 65 usual squamous cell carcinoma (USCC), 1 verrucous, 4 basaloid, 1 warty, and 1 mixed (warty-basaloid), was collected. Immunohistochemistry (IHC) was performed to assess PD-L1 expression using two different anti-PD-L1 antibodies (clone SP263 and SP142 Ventana) and MMR proteins expression using anti-MLH1, anti-PMS2, anti-MSH2, and anti-MSH6 antibodies. PCR analysis was performed for the detection of MSI status. Results Of the 72 PC cases analyzed by IHC, 45 (62.5%) cases were TC positive and 57 (79%) cases were combined positive score (CPS) using PDL1 SP263. In our cohort, TILs were present in 62 out of 72 cases (86.1%), 47 (75.8%) out of 62 cases showed positivity to PDL1 clone SP142. In our series, 59 cases (82%) had pMMR, 12 cases (16.7%) had lo-paMMR, and only 1 case (1.3%) had MMR. PCR results showed that only one case lo-paMMR was MSI-H, and the case dMMR by IHC not confirmed MSI status. Conclusion Our findings showed that PD-L1 expression and MSI status represent frequent biological events in this tumor suggesting a rationale for a new frontier in the treatment of patients with PC based on the immune checkpoint inhibitors.
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Affiliation(s)
- Marco Montella
- Pathology Unit, Department of Mental Health, Physic and Preventive Medicine University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosalaura Sabetta
- Pathology Unit, Department of Mental Health, Physic and Preventive Medicine University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, Department of Mental Health, Physic and Preventive Medicine University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco De Sio
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Davide Arcaniolo
- Urology Unit, Department of Woman Child and of General and Specialist Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ferdinando De Vita
- Oncology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Tirino
- Oncology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Caputo
- Department of Medicine and Surgery, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", University of Salerno, Salerno, Italy
| | - Antonio D'Antonio
- Department of Pathology, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Salerno, Italy
| | | | - Gaetano Facchini
- Medical Oncology Unit, S.M. delle Grazie Hospital, Pozzuoli, Italy
| | | | - Sisto Perdonà
- Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy
| | - Jole Ventriglia
- Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy
| | - Gabriella Aquino
- Pathology Unit, Istituto Nazionale Tumori Fondazione G. Pascale IRCCS, Naples, Italy
| | - Florinda Feroce
- Pathology Unit, Istituto Nazionale Tumori Fondazione G. Pascale IRCCS, Naples, Italy
| | - Rodolfo Borges Dos Reis
- Urology Division, Department of Surgery and Anatomy, Ribeirão Preto School Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | - Luciano Neder
- Department of Pathology and Forensic Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Matteo Brunelli
- Department of Pathology, University of Verona, Verona, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental Health, Physic and Preventive Medicine University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental Health, Physic and Preventive Medicine University of Campania "Luigi Vanvitelli", Naples, Italy
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Joshi VB, Chadha J, Chahoud J. Penile cancer: Updates in systemic therapy. Asian J Urol 2022; 9:374-388. [DOI: 10.1016/j.ajur.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022] Open
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Lu X, Lu X. Enhancing immune checkpoint blockade therapy of genitourinary malignancies by co-targeting PMN-MDSCs. Biochim Biophys Acta Rev Cancer 2022; 1877:188702. [PMID: 35227829 PMCID: PMC9177662 DOI: 10.1016/j.bbcan.2022.188702] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 12/20/2022]
Abstract
Immune checkpoint blockade (ICB) as a powerful immunotherapy has transformed cancer treatment. The application of ICB to genitourinary malignancies has generated substantial clinical benefits for patients with advanced kidney cancer or bladder cancer, yet very limited response to ICB therapy was observed from metastatic castration-resistant prostate cancer. The efficacy of ICB in rare genitourinary tumors (e.g. penile cancer) awaits results from ongoing clinical trials. A potential barrier for ICB is tumor-infiltrating polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs) with their functions and mechanisms recently revealed. Preclinical studies suggest that successful therapeutic inhibition of PMN-MDSCs synergizes effectively with ICB to eradicate ICB-refractory genitourinary malignancies.
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Affiliation(s)
- Xuemin Lu
- Department of Biological Sciences, Boler-Parseghian Center for Rare and Neglected Diseases, Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Xin Lu
- Department of Biological Sciences, Boler-Parseghian Center for Rare and Neglected Diseases, Harper Cancer Research Institute, University of Notre Dame, Notre Dame, IN 46556, USA; Tumor Microenvironment and Metastasis Program, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA.
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Mei X, Zhao Y, Zhang Y, Liao J, Jiang C, Qian H, Du Y. Efficacy and Biomarker Exploration of Sintilimab Combined With Chemotherapy in the Treatment of Advanced Penile Squamous Cell Carcinoma-A Report of Two Cases. Front Oncol 2022; 12:823459. [PMID: 35463336 PMCID: PMC9021724 DOI: 10.3389/fonc.2022.823459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Penile squamous cell carcinoma is a rare malignant tumor of the male reproductive system. We report two cases of advanced penile squamous cell carcinoma with persistent partial response/complete response after sintilimab combined with chemotherapy and analyze the relevant tumor biomarkers.
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Affiliation(s)
- Xinkuan Mei
- Department of Oncology, Fuyang Tumor Hospital, Fuyang, China
| | - Yanyan Zhao
- Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yiruo Zhang
- Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jinhua Liao
- Department of Oncology, Fuyang Tumor Hospital, Fuyang, China
| | - Chen Jiang
- Department of Oncology, Fuyang Tumor Hospital, Fuyang, China
| | - Hesheng Qian
- Department of Oncology, Fuyang Tumor Hospital, Fuyang, China
| | - Yingying Du
- Department of Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, China
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[Molecular diagnostics and molecular tumor board in uro-oncology : Precision medicine using the example of metastatic castration-resistant prostate cancer]. Urologe A 2022; 61:311-322. [PMID: 35157098 DOI: 10.1007/s00120-022-01784-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
Novel approaches to molecular tumor profiling evaluate DNA, RNA and protein alterations to create a detailed molecular map that enables precise and personalized treatment decisions. As the field of molecular profiling is constantly evolving, the training and networking of doctors is of decisive importance. Through the establishment of precision medicine with precision oncological consultations supported by interdisciplinary molecular tumor boards, many patients with difficult to treat tumor diseases can be advised and treated. Many pathophysiological relationships in progressive tumors can be elucidated resulting in new therapeutic options for the profiled patients; however, understanding the complex mutational profiles remains a very demanding task that requires a suitably trained and committed team that should be in close contact with the scientific advancements in precision oncology.
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Müller T, Demes M, Lehn A, Köllermann J, Vallo S, Wild PJ, Winkelmann R. The peri- and intratumoral immune cell infiltrate and PD-L1 status in invasive squamous cell carcinomas of the penis. Clin Transl Oncol 2021; 24:331-341. [PMID: 34449004 PMCID: PMC8794908 DOI: 10.1007/s12094-021-02694-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/08/2021] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Penile carcinomas are rare tumors throughout Europe. Therefore, little attention is drawn to this disease. That makes it important to study tumor-associated key metrics and relate these to known data on penile neoplasias. MATERIALS AND METHODS A cohort of 60 well-defined penile invasive carcinomas with known human papillomavirus (HPV) infection status was investigated. Data on tumor type, grading and staging were recorded. Additionally, data on the peri- and intratumoral immune cell infiltrate in a semiquanititave manner applying an HE stain were assessed. RESULTS Our study showed a significant correlation of immune cell infiltrate and pT stage with overall survival. Therefore, in a subset of tumors, PD-L1 staining was applied. For tumor proportion score (TPS), 26 of 30 samples (87%) were scored >0%. For the immune cell score (IC), 28 of 30 samples (93%) were defined as >0% and for CPS, 29 of 30 samples (97%) scored >0. PD-L1 expression was not associated with overall survival. CONCLUSION PD-L1 is expressed in penile carcinomas, providing a rationale for targeted therapy with checkpoint inhibitors. We were able to show that immune reaction appears to be prognostically relevant. These data enhance the need for further studies on the immune cell infiltrate in penile neoplasias and show that PD-L1 expression is existent in our cohort, which may be a potential target for checkpoint inhibitor therapy.
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Affiliation(s)
- T Müller
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - M Demes
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - A Lehn
- Institute of Biostatistics and Mathematical Modeling, Goethe University, Frankfurt am Main, Germany
| | - J Köllermann
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - S Vallo
- Institute of Virology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - P J Wild
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany.,Frankfurt Institute for Advanced Studies (FIAS), Frankfurt am Main, Germany
| | - R Winkelmann
- Dr. Senckenberg Institute of Pathology, Goethe University, University Hospital Frankfurt, Frankfurt am Main, Germany.
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Masterson TA, Tagawa ST. A 25-year perspective on advances in an understanding of the biology, evaluation, treatment and future directions/challenges of penile cancer. Urol Oncol 2021; 39:569-576. [PMID: 34219002 DOI: 10.1016/j.urolonc.2021.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023]
Abstract
Squamous cell carcinoma of the penis (SCCP) is uncommon in some countries (including the U.S.), but is an important malignancy elsewhere. As a rare disease, progress has been slow compared to more common tumor types discussed in this anniversary issue and most often limited to single-center or retrospective datasets. In this section we describe developments leading to the current standard approach with current research questions.
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Affiliation(s)
- Timothy A Masterson
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN
| | - Scott T Tagawa
- Division of Hematology & Medical Oncology, Department of Medicine and Department of Urology, Weill Cornell Medicine, New York, NY.
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Kakies C, Louise Dräger D, Spiess P, Hakenberg OW, Protzel C. [Conventional grading vs. molecular grading : Decision aids for clinical routine]. Urologe A 2021; 60:886-894. [PMID: 34184100 DOI: 10.1007/s00120-021-01574-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
Conventional histopathological grading of a cancer is of utmost importance for the management and prognosis of the patient. Histopathological grading is predominantly a function of the differentiation and proliferation of tumor cells, the amount of necrosis present and the pattern of invasion. In addition, the molecular set-up of a given cancer which can be determined to some degree by immunohistochemistry or by methods analyzing genetic and epigenetic alterations can be used in some instances to improve the information gained by conventional histopathologic grading. Indeed, this latter option implies the promise of individualized tumor therapy. While this promise is on the horizon, the clinical implications for penile cancer are not yet transferable to individualized penile cancer treatment.
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Affiliation(s)
- C Kakies
- ZEMODIAG, Zentrum für morphologische Diagnostik Leipzig, Muldentalstraße 66, 04288, Leipzig, Deutschland.
| | - D Louise Dräger
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - P Spiess
- Department of Genitourinary Oncology, Moffitt Cancer Center, University of Texas, Tampa, FL, 33612, USA
| | - O W Hakenberg
- Klinik und Poliklinik für Urologie, Universitätsmedizin Rostock, Rostock, Deutschland
| | - C Protzel
- Klinik für Urologie, Helios-Klink Schwerin, Schwerin, Deutschland
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Savoie PH, Morel-Journel N, Murez T, Ferretti L, Rocher L, Fléchon A, Camparo P, Méjean A. [French ccAFU guidelines - update 2020-2022: penile cancer]. Prog Urol 2021; 30:S252-S279. [PMID: 33349426 DOI: 10.1016/s1166-7087(20)30753-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE - To update French oncology guidelines concerning penile cancer. METHODS - Comprehensive Medline search between 2018 and 2020 upon diagnosis, treatment and follow-up of testicular germ cell cancer to update previous guidelines. Level of evidence was evaluated according to AGREE-II. RESULTS - Epidermoid carcinoma is the most common penile cancer histology. Physical examination is mandatory to define local and inguinal nodal cancer stage. MRI with artificial erection can help to assess deep infiltration in cases of organ-sparing intention. Node negative patients (defined by palpation and imaging) will present micro nodal metastases in up to 25% of cases. Invasive lymph node assessment is thus advocated except for low risk patients. Sentinel node dynamic biopsy is the first line technique. Modified bilateral inguinal lymphadenectomy is an option with higher morbidity. 18-FDG-PET is recommended in patients with palpable nodes. Chest, abdominal and pelvis computerized tomography is an option. Fine needle aspiration (when positive) is an easy way to assess inguinal palpable node pathological involvement. Its results determine the type of lymphadenectomy to be performed (for diagnostic or curative purposes). Treatment is mostly surgical. Free margins status is essential, but it also has to be organ-sparing when possible. Brachytherapy and topic agents can cure in selected cases. Lymph node assessment should be synchronous to the removal of the tumour when possible. Limited inguinal lymph node involvement (pN1 stage) can be cured with the only lymphadenectomy. In case of larger lymph node stage, one should consider multidisciplinary treatment including chemotherapy and inclusion in a trial. CONCLUSIONS - Penile cancer needs demanding surgery to be cured, surrounded by chemotherapy in node positive patients. Lymph nodes involvement is a major prognostic factor. Thus, inguinal node assessment cannot be neglected.
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Affiliation(s)
- P-H Savoie
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de chirurgie urologique, hôpital d'instruction des armées Sainte-Anne, 2, boulevard Sainte-Anne, BP 600, 83800 Toulon, Cedex 09, France.
| | - N Morel-Journel
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie, CHU de Lyon, 165 chemin du Grand-Revoyet, 69310 Pierre-Bénite, France
| | - T Murez
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et de transplantation rénale, CHU de Montpellier, 371 avenue du Doyen-Gaston-Giraud, 34295 Montpellier, Cedex 5, France
| | - L Ferretti
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; MSP Bordeaux Bagatelle, 203, route de Toulouse, 33401 Talence, France
| | - L Rocher
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service de radiologie, hôpital Antoine-Béclère, APHP, 157 rue de la Porte-de-Trivaux, 92140 Clamart, France; Université Paris-Saclay, BIOMAPS, 63, avenue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - A Fléchon
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P Camparo
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Institut de pathologie des Hauts-de-France, 51, rue Jeanne-d'Arc, 80000 Amiens, France
| | - A Méjean
- Comité de Ccancérologie de l'Association française d'urologie, groupe organes génitaux externes, Maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75015 Paris, France
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Stecca CE, Alt M, Jiang DM, Chung P, Crook JM, Kulkarni GS, Sridhar SS. Recent Advances in the Management of Penile Cancer: A Contemporary Review of the Literature. Oncol Ther 2021; 9:21-39. [PMID: 33454930 PMCID: PMC8140030 DOI: 10.1007/s40487-020-00135-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/18/2020] [Indexed: 12/16/2022] Open
Abstract
Penile cancer is a rare condition, which mostly affects men in their sixth decade of life. The most common histology is squamous cell carcinoma (SCC), with about half of the cases linked to human papilloma virus (HPV) infection. The lack of awareness and significant social and psychological stigma associated with penile cancer often leads to delays in presentation, diagnosis and management. Timely multidisciplinary care at experienced centers is therefore critical for improving outcomes. For patients with advanced disease, treatment options are limited and prognosis remains poor. Large international efforts are underway to further define the optimal standards of care. Targeted therapies and immune checkpoint inhibitors could potentially play a role in advanced disease and are under evaluation in clinical trials. In this review, we discuss the current management of penile cancer and future directions.
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Affiliation(s)
- Carlos E Stecca
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marie Alt
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Di Maria Jiang
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Juanita M Crook
- Department of Radiation Oncology, BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior, Vancouver, British Columbia, Canada
| | - Girish S Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Srikala S Sridhar
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
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Cimadamore A, Rizzo A, Mollica V, Massari F, Lopez-Beltran A, Scarpelli M, Cheng L, Santoni M, Montironi R. An update on immunotherapy in uro-oncology. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2021. [DOI: 10.1080/23808993.2021.1911638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Alessandro Rizzo
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Veronica Mollica
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Francesco Massari
- Division of Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, USA
| | | | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
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Lehmer L, Choi F, Kraus C, Shiu J, de Feraudy S, Elsensohn A. Histopathologic PD-L1 Tumor Expression and Prognostic Significance in Nonmelanoma Skin Cancers: A Systematic Review. Am J Dermatopathol 2021; 43:321-330. [PMID: 33910221 DOI: 10.1097/dad.0000000000001772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT PD-L1 and PD-1 inhibitors are being increasingly used to treat a variety of nonmelanoma skin cancers (NMSCs). This systematic review summarizes PD-L1 expression in NMSCs and determines its use for prognosis using targeted immunotherapy. A primary search of peer-reviewed English-language medical literature was conducted for studies on PD-L1 tumor expression in biopsied or excised NMSCs. Fifty-nine articles met criteria for inclusion. PD-L1 expression in advanced NMSCs ranged from 22%-89% for basal cell carcinomas, 42%-50% for Merkel cell carcinomas, and 26%-100% for squamous cell carcinomas. Study limitations included clone heterogeneity across studies, complicating comparison of PD-L1 expression. Differences were also noted in the selection of tumor reactivity threshold. We conclude that there is insufficient evidence to determine the prognostic significance of PD-L1 expression in NMSCs as a whole, but this remains a promising area. More investigation into the role of tumor PD-L1 as a biomarker for predicting clinical response to PD-L1 and PD-1 inhibitors in NMSCs is needed.
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Affiliation(s)
- Larisa Lehmer
- Resident, Department of Dermatology, University of California Irvine, Irvine, CA
| | - Franchesca Choi
- Research Fellow and Resident, School of Medicine, University of California Irvine, Irvine, CA
- Research Fellow and Resident, Department of Pathology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Christina Kraus
- Assistant Professor, Department of Dermatology, University of California Irvine, Irvine, CA
| | - Jessica Shiu
- Assistant Professor, Department of Dermatology, University of California Irvine, Irvine, CA
| | - Sebastien de Feraudy
- Dermatopathologist, Kaiser Regional Dermatopathology Service, Kaiser Permanente, San Francisco, CA; and
| | - Ashley Elsensohn
- Fellow, Dermatopathology Section, Geisinger Medical Center, Danville, PA
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Penile Cancer-Derived Cells Molecularly Characterized as Models to Guide Targeted Therapies. Cells 2021; 10:cells10040814. [PMID: 33917394 PMCID: PMC8067406 DOI: 10.3390/cells10040814] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 12/11/2022] Open
Abstract
Penile cancer (PeCa) is a common disease in poor and developing countries, showing high morbidity rates. Despite the recent progress in understanding the molecular events involved in PeCa, the lack of well-characterized in vitro models precludes new advances in anticancer drug development. Here we describe the establishment of five human primary penile cancer-derived cell cultures, including two epithelial and three cancer-associated fibroblast (CAF) cells. Using high-throughput genomic approaches, we found that the epithelial PeCa derived- cells recapitulate the molecular alterations of their primary tumors and present the same deregulated signaling pathways. The differentially expressed genes and proteins identified are components of key oncogenic pathways, including EGFR and PI3K/AKT/mTOR. We showed that epithelial PeCa derived cells presented a good response to cisplatin, a common therapeutic approach used in PeCa patients. The growth of a PeCa-derived cell overexpressing EGFR was inhibited by EGFR inhibitors (cetuximab, gefitinib, and erlotinib). We also identified CAF signature markers in three PeCa-derived cells with fibroblast-like morphology, indicating that those cells are suitable models for PeCa microenvironment studies. We thus demonstrate the utility of PeCa cell models to dissect mechanisms that promote penile carcinogenesis, which are useful models to evaluate therapeutic approaches for the disease.
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Pembrolizumab for advanced penile cancer: a case series from a phase II basket trial. Invest New Drugs 2021; 39:1405-1410. [PMID: 33770291 DOI: 10.1007/s10637-021-01100-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/10/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Treatment options for unresectable, locally advanced or metastatic penile squamous cell carcinoma (SCC) are limited. Previous studies have shown that 40-62% of patients with penile SCC express PD-L1. We report three cases of locally advanced or metastatic penile SCC treated with pembrolizumab. CASE PRESENTATIONS Herein, we present three patients with recurrent, locally advanced or metastatic penile SCC who progressed on a platinum-based chemotherapy triplet and were treated with pembrolizumab, administered as part of a phase II clinical trial for rare tumors (NCT02721732). One patient with a microsatellite instability high (MSI-H) tumor experienced a durable partial response to pembrolizumab, underwent surgical consolidation, and remains disease-free 38.7 months later. Two patients experienced progressive disease within 3 months of beginning pembrolizumab. No one experienced a grade 3 or worse treatment-related adverse event. CONCLUSION In sum, single-agent pembrolizumab was well tolerated as salvage therapy in a small cohort of patients with unresectable, locally advanced or metastatic penile SCC. Pembrolizumab produced an objective response in an MSI-H tumor, yet it did not control disease in two patients with MSS penile SCC. Rationale combination therapies, including pembrolizumab, warrant further investigation. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02721732 . Registered March 23, 2016.
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PD-L1 expression in anogenital and oropharyngeal squamous cell carcinomas associated with different clinicopathological features, HPV status and prognosis: a meta-analysis. Biosci Rep 2021; 41:228067. [PMID: 33704390 PMCID: PMC8011230 DOI: 10.1042/bsr20203669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Little research has been done on clinicopathological
characteristics and human papillomavirus (HPV) status of anogenital and
oropharyngeal squamous cell carcinomas (SCC) with a strong expression of
programmed death ligand 1 (PD-L1) in tumor cells. Therefore, we conducted this
meta-analysis. Methods: We performed a comprehensive research in
PubMed, Embase and Cochrane databases up to 30 September 2020. The effect size
was hazard ratio (HR) with 95% confidence interval (CI) for overall
survival (OS), cancer-specific survival (CSS), disease-free survival (DFS). The
pooled odds ratio (OR) with 95% CI were used to assess the association
between PD-L1 expression and clinicopathological features along with HPV status.
Results: A total of 2003 cases (944 anogenital and 1059
oropharynx SCC patients) were included. High PD-L1 expression in anogenital SCC
cases were associated with advanced age (OR = 1.63, 95% CI:
1.04–2.58) and HPV negativity (OR = 0.47, 95% CI:
0.31–0.71). Besides, PD-L1 positive anogenital SCC cases held a
significantly declined OS (HR = 2.18, 95% CI: 1.37–3.47)
and CSS (HR = 2.45, 95% CI: 1.30–4.65). For oropharynx SCC,
PD-L1 was more frequent in younger and HPV positive patients (OR = 0.60,
95% CI: 0.37–0.98; OR = 3.01, 95% CI:
1.78–5.09) and PD-L1 expression was relevant to better OS and DFS (HR
= 0.76, 95% CI: 0.60–0.97; HR = 0.50, 95% CI:
0.33–0.75). Conclusions: The meta-analysis demonstrated that
in anogenital SCC, PD-L1 positivity had to do with a worse outcome, which might
attribute to advanced age, higher tumor grade, lymph node metastasis and HPV
negativity, while in oropharynx cancer, PD-L1 expression was related to better
prognosis for the reason that PD-L1 was less frequent in the aged and negative
HPV status.
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Ayoubian H, Heinzelmann J, Hölters S, Khalmurzaev O, Pryalukhin A, Loertzer P, Heinzelbecker J, Lohse S, Geppert C, Loertzer H, Wunderlich H, Bohle RM, Stöckle M, Matveev VB, Hartmann A, Junker K. miRNA Expression Characterizes Histological Subtypes and Metastasis in Penile Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:1480. [PMID: 33807023 PMCID: PMC8004785 DOI: 10.3390/cancers13061480] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
Although microRNAs are described as promising biomarkers in many tumor types, little is known about their role in PSCC. Thus, we attempted to identify miRNAs involved in tumor development and metastasis in distinct histological subtypes considering the impact of HPV infection. In a first step, microarray analyses were performed on RNA from formalin-fixed, paraffin-embedded tumor (22), and normal (8) tissue samples. Microarray data were validated for selected miRNAs by qRT-PCR on an enlarged cohort, including 27 tumor and 18 normal tissues. We found 876 significantly differentially expressed miRNAs (p ≤ 0.01) between HPV-positive and HPV-negative tumor samples by microarray analysis. Although no significant differences were detected between normal and tumor tissue in the whole cohort, specific expression patterns occurred in distinct histological subtypes, such as HPV-negative usual PSCC (95 differentially expressed miRNAs, p ≤ 0.05) and HPV-positive basaloid/warty subtypes (247 differentially expressed miRNAs, p ≤ 0.05). Selected miRNAs were confirmed by qRT-PCR. Furthermore, microarray data revealed 118 miRNAs (p ≤ 0.01) that were significantly differentially expressed in metastatic versus non-metastatic usual PSCC. The lower expression levels for miR-137 and miR-328-3p in metastatic usual PSCC were validated by qRT-PCR. The results of this study confirmed that specific miRNAs could serve as potential diagnostic and prognostic markers in single PSCC subtypes and are associated with HPV-dependent pathways.
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Affiliation(s)
- Hiresh Ayoubian
- Department of Urology and Paediatric Urology, Saarland University, 66421 Homburg, Germany; (H.A.); (J.H.); (S.H.); (O.K.); (P.L.); (J.H.); (M.S.)
| | - Joana Heinzelmann
- Department of Urology and Paediatric Urology, Saarland University, 66421 Homburg, Germany; (H.A.); (J.H.); (S.H.); (O.K.); (P.L.); (J.H.); (M.S.)
- Department of Ophthalmology, Martin-Luther-University Halle-Wittenberg, 06120 Halle/Saale, Germany
| | - Sebastian Hölters
- Department of Urology and Paediatric Urology, Saarland University, 66421 Homburg, Germany; (H.A.); (J.H.); (S.H.); (O.K.); (P.L.); (J.H.); (M.S.)
| | - Oybek Khalmurzaev
- Department of Urology and Paediatric Urology, Saarland University, 66421 Homburg, Germany; (H.A.); (J.H.); (S.H.); (O.K.); (P.L.); (J.H.); (M.S.)
- Department of Urology, Federal State Budgetary Institution “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 115478 Moscow, Russia;
| | - Alexey Pryalukhin
- Institute of Pathology, Saarland University Medical Centre, 66421 Homburg, Germany; (A.P.); (R.M.B.)
| | - Philine Loertzer
- Department of Urology and Paediatric Urology, Saarland University, 66421 Homburg, Germany; (H.A.); (J.H.); (S.H.); (O.K.); (P.L.); (J.H.); (M.S.)
- Westpfalz-Klinikum, Clinic of Urology and Paediatric Urology, 67655 Kaiserslautern, Germany;
| | - Julia Heinzelbecker
- Department of Urology and Paediatric Urology, Saarland University, 66421 Homburg, Germany; (H.A.); (J.H.); (S.H.); (O.K.); (P.L.); (J.H.); (M.S.)
| | - Stefan Lohse
- Institute of Virology, Saarland University, 66421 Homburg, Germany;
| | - Carol Geppert
- Institute of Pathology, University Erlangen-Nuremberg, 91054 Erlangen, Germany; (C.G.); (A.H.)
| | - Hagen Loertzer
- Westpfalz-Klinikum, Clinic of Urology and Paediatric Urology, 67655 Kaiserslautern, Germany;
| | - Heiko Wunderlich
- St. Georg Klinikum, Clinic of Urology and Paediatric Urology, 99817 Eisenach, Germany;
| | - Rainer M. Bohle
- Institute of Pathology, Saarland University Medical Centre, 66421 Homburg, Germany; (A.P.); (R.M.B.)
| | - Michael Stöckle
- Department of Urology and Paediatric Urology, Saarland University, 66421 Homburg, Germany; (H.A.); (J.H.); (S.H.); (O.K.); (P.L.); (J.H.); (M.S.)
| | - Vsevolod Borisovich Matveev
- Department of Urology, Federal State Budgetary Institution “N.N. Blokhin National Medical Research Center of Oncology” of the Ministry of Health of the Russian Federation, 115478 Moscow, Russia;
| | - Arndt Hartmann
- Institute of Pathology, University Erlangen-Nuremberg, 91054 Erlangen, Germany; (C.G.); (A.H.)
| | - Kerstin Junker
- Department of Urology and Paediatric Urology, Saarland University, 66421 Homburg, Germany; (H.A.); (J.H.); (S.H.); (O.K.); (P.L.); (J.H.); (M.S.)
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Steck S, Went P, Cathomas R, Kienle D. Profound and durable responses with PD-1 immune checkpoint inhibitors in patients with metastatic penile squamous cell carcinoma. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2021. [DOI: 10.1016/j.cpccr.2020.100045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Chahoud J, Kohli M, Spiess PE. Management of Advanced Penile Cancer. Mayo Clin Proc 2021; 96:720-732. [PMID: 33308870 DOI: 10.1016/j.mayocp.2020.06.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 12/24/2022]
Abstract
Penile squamous cell carcinoma (PSCC) is a rare cancer, with approximately 2000 new cases in the United States and 35,000 globally every year. Multiple risk factors are involved in PSCC, but most importantly, the high-risk human papillomavirus infection is thought to be present in approximately 50% of cases. Penile squamous cell carcinoma presents as localized or locally advanced disease. Multiple prognostic markers have been explored over the past 3 decades, but lymph node status remains the strongest predictor of clinical outcomes. Surgical decisions are based on the primary tumor pathologic findings, nodal clinical examination, and imaging results. Most patients with high-risk advanced PSCC benefit from a multimodal treatment approach combining chemotherapy with consolidation surgical treatment. The role of neoadjuvant chemotherapy with radiation therapy has not been well explored in PSCC. Prospective clinical studies, like the International Penile Advanced Cancer Trial, have been launched to provide high-level evidence for multimodal treatment. The International Penile Advanced Cancer Trial is the first randomized clinical trial among patients with PSCC and is currently accruing, with the expectation to generate results in 2023. Unfortunately, most patients with high-risk locally advanced PSCC will have relapsed or refractory cancer after cisplatin-based combination chemotherapy. These patients have dismal outcomes with salvage chemotherapy, highlighting the major unmet need to expand our knowledge of the disease's biology and develop clinical trials that use novel systemic agents. This narrative review synthesizes relevant publications retrieved from PubMed. Our aim is to discuss current approaches in the management of PSCC, summarize ongoing efforts to improve care, and identify future areas for enhancing our understanding of the disease.
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Affiliation(s)
- Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL. https://twitter.com/JadChahoud
| | - Manish Kohli
- Department of Genitourinary Oncology, Huntsman Cancer Institute, Salt Lake City, UT
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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Badia-Ramentol J, Linares J, Gómez-Llonin A, Calon A. Minimal Residual Disease, Metastasis and Immunity. Biomolecules 2021; 11:130. [PMID: 33498251 PMCID: PMC7909268 DOI: 10.3390/biom11020130] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/11/2022] Open
Abstract
Progression from localized to metastatic disease requires cancer cells spreading to distant organs through the bloodstream. Only a small proportion of these circulating tumor cells (CTCs) survives dissemination due to anoikis, shear forces and elimination by the immune system. However, all metastases originate from CTCs capable of surviving and extravasating into distant tissue to re-initiate a tumor. Metastasis initiation is not always immediate as disseminated tumor cells (DTCs) may enter a non-dividing state of cell dormancy. Cancer dormancy is a reversible condition that can be maintained for many years without being clinically detectable. Subsequently, late disease relapses are thought to be due to cancer cells ultimately escaping from dormant state. Cancer dormancy is usually associated with minimal residual disease (MRD), where DTCs persist after intended curative therapy. Thus, MRD is commonly regarded as an indicator of poor prognosis in all cancers. In this review, we examine the current understanding of MRD and immunity during cancer progression to metastasis and discuss clinical perspectives for oncology.
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Affiliation(s)
| | | | | | - Alexandre Calon
- Cancer Research Program, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain; (J.B.-R.); (J.L.); (A.G.-L.)
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Chahoud J, Skelton WP, Spiess PE, Walko C, Dhillon J, Gage KL, Johnstone PAS, Jain RK. Case Report: Two Cases of Chemotherapy Refractory Metastatic Penile Squamous Cell Carcinoma With Extreme Durable Response to Pembrolizumab. Front Oncol 2020; 10:615298. [PMID: 33425770 PMCID: PMC7793656 DOI: 10.3389/fonc.2020.615298] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/17/2020] [Indexed: 01/17/2023] Open
Abstract
Background Penile squamous cell carcinoma (PSCC) is a rare malignancy, and those patients with metastatic disease have limited treatment options. Treatment is largely comprised of platinum-based chemotherapy; however, patients progressing after initial chemotherapy have a median overall survival (OS) of less than 6 months. Based on a high percentage of PD-L1 expression in patients with PSCC, and its biological similarities to other squamous cell carcinomas, we present two patient cases treated with pembrolizumab with extraordinary durable treatment response far beyond treatment with standard therapy. Main Body The first patient is a 64 year old male with PSCC who was treated with neoadjuvant chemotherapy, partial penectomy, and adjuvant radiation prior to developing metastatic disease. He had a high TMB (14 mutations/Mb) and was started on pembrolizumab with a complete response, which has been maintained for 38 months. The second patient is an 85 year old male with PSCC who was treated with partial penectomy and adjuvant chemotherapy and radiation prior to developing metastatic disease. He had positive PD-L1 expression CPS 130) and was started on pembrolizumab with a partial response, which has been maintained for 18 months after starting treatment. Conclusions These two cases of extreme durable response with pembrolizumab (with molecular data including TMB and PD-L1 status) represent a significant clinical benefit in this patient population. With limited treatment options that result in a median OS of less than 6 months, along with the toxicity profile of chemotherapy which may not be tolerated in elderly patients with comorbidities, this survival benefit with pembrolizumab, along with advances in tumor sequencing and clinical trials shows that there is a potentially significant benefit with novel therapies in this patient population.
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Affiliation(s)
- Jad Chahoud
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - William Paul Skelton
- Division of Medical Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Philippe E Spiess
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Christine Walko
- Division of Individualized Cancer Management, Personalized Medicine, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Jasreman Dhillon
- Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Kenneth L Gage
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Peter A S Johnstone
- Departments of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
| | - Rohit K Jain
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL, United States
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Halbert B, Einstein DJ. Hot or Not: Tumor Mutational Burden (TMB) as a Biomarker of Immunotherapy Response in Genitourinary Cancers. Urology 2020; 147:119-126. [PMID: 33137348 DOI: 10.1016/j.urology.2020.10.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 12/31/2022]
Abstract
Pembrolizumab was recently approved for treatment of cancers with high tumor mutational burden (TMB). We conduct a focused literature review of TMB as a predictive biomarker. TMB quantifies the sum of nonsynonymous coding mutations (typically single nucleotide substitutions and short insertion-deletions) per megabase of sequenced DNA. As a proxy for expression of immunogenic neoantigens, TMB may be an effective predictive biomarker for response to immune checkpoint inhibitors. However, like other biomarkers in this setting, TMB has many limitations; the effect of this FDA approval in the current management of genitourinary cancers is likely limited to select situations.
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Affiliation(s)
- Brian Halbert
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA
| | - David J Einstein
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Boston, MA.
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Scharman CD, Sokol ES, Luongo T, Genega EM, Mathew P. Durable Remission of Human Papillomavirus–Positive JAK2/ PDL1/ PDL2–Amplified Urethral Squamous Carcinoma With Sequential Chemotherapy and Immune Checkpoint Inhibitor Therapy. JCO Precis Oncol 2020; 4:860-864. [DOI: 10.1200/po.19.00395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Tony Luongo
- Department of Urology, Tufts Medical Center, Boston, MA
| | - Elizabeth M. Genega
- Department of Pathology and Laboratory Medicine, Tufts Medical Center, Boston, MA
| | - Paul Mathew
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA
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