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Amicuzi U, Grillo M, Stizzo M, Olivetta M, Tammaro S, Napolitano L, Reccia P, De Luca L, Rubinacci A, Della Rosa G, Lecce A, Coppola P, Papi S, Trama F, Romano L, Sciorio C, Spirito L, Crocetto F, Manfredi C, Del Giudice F, Ferro M, Rocco B, Tataru OS, Balsamo R, Lucarelli G, Del Biondo D, Barone B. Exploring the Multifactorial Landscape of Penile Cancer: A Comprehensive Analysis of Risk Factors. Diagnostics (Basel) 2024; 14:1790. [PMID: 39202278 PMCID: PMC11353487 DOI: 10.3390/diagnostics14161790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/10/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
Penile cancer, while rare, is a critical public health issue due to its profound impact on patients and the complexities of its management. The disease's multifactorial etiology includes risk factors such as HPV infection, poor hygiene, smoking, genetic predispositions, and socioeconomic determinants. This article provides a comprehensive review and analysis of these diverse risk factors, aiming to enhance understanding of the disease's underlying causes. By elucidating these factors, the article seeks to inform and improve prevention strategies, early detection methods, and therapeutic interventions. A nuanced grasp of the multifactorial nature of penile cancer can enable healthcare professionals to develop more effective approaches to reducing incidence rates and improving patient outcomes.
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Affiliation(s)
- Ugo Amicuzi
- Division of Urology, Department of Surgical Sciences, AORN Sant’Anna e San Sebastiano, 81100 Caserta, Italy;
| | - Marco Grillo
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy; (M.G.); (D.D.B.)
| | - Marco Stizzo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.); (C.M.)
| | - Michelangelo Olivetta
- Urology Unit, Gaetano Fucito Hospital, AOU San Giovanni di Dio e Ruggi d’Aragona, 84085 Mercato San Severino, Italy;
| | - Simone Tammaro
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (S.T.); (L.N.); (A.R.); (G.D.R.); (A.L.); (P.C.); (S.P.); (L.R.); (F.C.)
| | - Luigi Napolitano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (S.T.); (L.N.); (A.R.); (G.D.R.); (A.L.); (P.C.); (S.P.); (L.R.); (F.C.)
| | - Pasquale Reccia
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (R.B.)
| | - Luigi De Luca
- Division of Urology, Department of Surgical Multispecialty, AORN Antonio Cardarelli, 80131 Naples, Italy;
| | - Andrea Rubinacci
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (S.T.); (L.N.); (A.R.); (G.D.R.); (A.L.); (P.C.); (S.P.); (L.R.); (F.C.)
| | - Giampiero Della Rosa
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (S.T.); (L.N.); (A.R.); (G.D.R.); (A.L.); (P.C.); (S.P.); (L.R.); (F.C.)
| | - Arturo Lecce
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (S.T.); (L.N.); (A.R.); (G.D.R.); (A.L.); (P.C.); (S.P.); (L.R.); (F.C.)
| | - Paola Coppola
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (S.T.); (L.N.); (A.R.); (G.D.R.); (A.L.); (P.C.); (S.P.); (L.R.); (F.C.)
| | - Salvatore Papi
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (S.T.); (L.N.); (A.R.); (G.D.R.); (A.L.); (P.C.); (S.P.); (L.R.); (F.C.)
| | - Francesco Trama
- Urology Complex Unit, ASL Napoli 2 Nord ‘Santa Maria delle Grazie’ Hospital, 80078 Pozzuoli, Italy;
| | - Lorenzo Romano
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (S.T.); (L.N.); (A.R.); (G.D.R.); (A.L.); (P.C.); (S.P.); (L.R.); (F.C.)
| | | | - Lorenzo Spirito
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.); (C.M.)
| | - Felice Crocetto
- Department of Neurosciences and Reproductive Sciences and Odontostomatology, University of Naples Federico II, 80131 Naples, Italy; (S.T.); (L.N.); (A.R.); (G.D.R.); (A.L.); (P.C.); (S.P.); (L.R.); (F.C.)
| | - Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (M.S.); (L.S.); (C.M.)
| | | | - Matteo Ferro
- 2nd Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, 20142 Milan, Italy (B.R.)
| | - Bernardo Rocco
- 2nd Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Via A. Di Rudini 8, 20142 Milan, Italy (B.R.)
| | - Octavian Sabin Tataru
- Department of Simulation Applied in Medicine, The Institution Organizing University Doctoral Studies (I.O.S.U.D.), George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology from Târgu Mureș, 540142 Târgu Mureș, Romania;
| | - Raffaele Balsamo
- Urology Unit, AORN Ospedali dei Colli, Monaldi Hospital, 80131 Naples, Italy; (P.R.); (R.B.)
| | - Giuseppe Lucarelli
- Urology, Andrology and Kidney Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy;
| | - Dario Del Biondo
- Department of Urology, Ospedale del Mare, ASL NA1 Centro, 80147 Naples, Italy; (M.G.); (D.D.B.)
- Department of Urology, Ospedale San Paolo, ASL NA1 Centro, 80125 Naples, Italy
| | - Biagio Barone
- Department of Urology, Ospedale San Paolo, ASL NA1 Centro, 80125 Naples, Italy
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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 PMCID: PMC11290867 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] [Grants] [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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3
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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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Tekin B, Cubilla AL, Cheville JC, Smith CY, Jenkins SM, Dasari S, Enninga EAL, Norgan AP, Menon S, Whaley RD, Hernandez LH, Jimenez RE, Garcia JJ, Thompson RH, Leibovich BC, Karnes RJ, Boorjian SA, Pagliaro LC, Erickson LA, Guo R, Gupta S. High-risk human papilloma virus status & outcomes for penile squamous cell carcinoma: A single institution experience. Hum Pathol 2024; 150:9-19. [PMID: 38909709 DOI: 10.1016/j.humpath.2024.06.013] [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: 05/24/2024] [Revised: 06/18/2024] [Accepted: 06/20/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVES There is a paucity of data on North American cohorts of patients with penile squamous cell carcinoma (pSCC). Herein, we aimed to assess the sensitivity of various modalities to identify human papillomavirus (HPV) status, determine the prevalence of high-risk HPV-positivity, and evaluate the prognostic impact of relevant clinicopathologic variables. METHODS Patients with pSCC (n = 121) consecutively treated with partial/total penectomy (2000-2022) at a single institution were included. HPV status (based on immunohistochemistry [IHC], in situ hybridization [ISH], and panviral metagenomic sequencing [PMS]), histologic features, and outcomes were reviewed. Outcome events included death due to disease and progression. RESULTS The majority of patients were white (105/121, 86.8%). Thirty-seven (30.6%) were high-risk HPV-positive, and morphologic evaluation had a sensitivity of 97.3% (95% confidence interval [CI], 86.2-99.5) for predicting high-risk HPV status compared to IHC/ISH/PMS. Disease progression was more common among high-risk HPV-negative compared to high-risk HPV-positive patients (HR 2.74, CI 1.12-8.23, P = 0.03). Moreover, among high-risk HPV-negative patients, those with moderate-poorly differentiated tumors had increased disease-specific mortality (32.6%, CI 17.1-48.1) compared to those with well-differentiated tumors (0%). Among high-risk HPV-positive patients, those with basaloid morphology had lower disease-specific mortality (0% vs 14.4%, CI 0.0-33.1). CONCLUSIONS We demonstrate high-risk HPV-positivity in approximately one-third of patients with pSCC. Morphologic evaluation alone had a high sensitivity in correctly determining HPV status. Our results suggest that high-risk HPV status and morphologic features (differentiation in high-risk HPV-negative, and basaloid subtype in high-risk HPV-positive pSCC) may have prognostic value.
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Affiliation(s)
- Burak Tekin
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Antonio L Cubilla
- Instituto de Patología e Investigación, Universidad Nacional de Asunción, Asunción, Paraguay.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| | - Carin Y Smith
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MM, USA.
| | - Sarah M Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MM, USA.
| | - Surendra Dasari
- Division of Biomedical Statistics & 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.
| | - 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.
| | - Joaquin J Garcia
- 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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Rajamohan N, Kapoor H, Khurana A, Nelson L, Ganesh HS, Khatri G, Nair RT. MR imaging of penile pathology and prostheses. Abdom Radiol (NY) 2024:10.1007/s00261-024-04417-2. [PMID: 39066812 DOI: 10.1007/s00261-024-04417-2] [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: 04/15/2024] [Revised: 05/24/2024] [Accepted: 05/26/2024] [Indexed: 07/30/2024]
Abstract
Penile MRI is a vital yet underutilized diagnostic tool that provides detailed information crucial for managing various penile pathologies. Due to its infrequent use, many radiology trainees lack confidence in interpreting these exams. This article reviews the anatomy, key technical considerations, and interpretive pearls for penile trauma, Peyronie's disease, priapism, penile neoplasms, prosthesis evaluation, and a few miscellaneous conditions. Through illustrative case examples, this review aims to enhance the understanding and proficiency of radiologists in performing and interpreting penile MRI in these clinical scenarios.
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Affiliation(s)
- Naveen Rajamohan
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9004, USA.
| | - Harit Kapoor
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
| | - Aman Khurana
- Department of Radiology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Leslie Nelson
- Department of Radiology, University of Wisconsin, Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Halemane S Ganesh
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
| | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9004, USA
| | - Rashmi T Nair
- Department of Radiology, University of Kentucky Chandler Medical Center, 800 Rose St. HX315E, Lexington, KY, USA
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Puente J, Algaba Arrea F, Buisán Rueda Ó, Castellano Gauna D, Durán I, Fernández Ávila JJ, Gómez-Iturriaga A, Parada Blázquez MJ, Pérez Fentes D, Sancho Pardo G, Vallejo Casas JA, Gratal P, Pardo MT, Guillem Porta V. Criteria and indicators to evaluate quality of care in genitourinary tumour boards. Clin Transl Oncol 2024; 26:1639-1646. [PMID: 38341809 DOI: 10.1007/s12094-024-03381-z] [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: 12/11/2023] [Accepted: 12/31/2023] [Indexed: 02/13/2024]
Abstract
PURPOSE Genitourinary (GU) multidisciplinary tumour boards (GUMTBs) are key components of patient care, as they might lead to changes in treatment plan, improved survival, and increased adherence to guidelines. However, there are no guidelines on how GUMTBs should operate or how to assess their quality of performance. METHODS A systematic literature review was conducted to identify criteria and indicators to evaluate quality in GUMTBs. A scientific committee-comprising 12 GU cancer specialists from seven disciplines-proposed a list of criteria and developed indicators, evaluated in two rounds of Delphi method. Appropriateness and utility of indicators were scored using a 9-point Likert scale. Consensus was defined as at least two-thirds of Delphi respondents selecting a score sub-category that encompassed the median score of the group. RESULTS Forty-five criteria were selected to evaluate the quality of GUMTBs covering five dimensions: organisation, personnel, protocol and documentation, resources, and interaction with patients. Then, 33 indicators were developed and evaluated in the first round of Delphi, leading to a selection of 26 indicators in two dimensions: function, governance and resources, and GUMTB sessions. In the second round, consensus was reached on the appropriateness of all 26 indicators and on the utility of 24 of them. Index cards for criteria and indicators were developed to be used in clinical practice. CONCLUSIONS Criteria and indicators were developed to evaluate the quality of GUMTBs, aiming to serve as a guide to improve quality of care and health outcomes in patients with GU cancer.
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Affiliation(s)
- Javier Puente
- Servicio de Oncología Médica, Hospital Universitario Clínico San Carlos, Madrid, Spain.
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain.
| | | | - Óscar Buisán Rueda
- Servicio de Urología, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Daniel Castellano Gauna
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
- Servicio de Oncología Médica, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Ignacio Durán
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
- Servicio de Oncología Médica, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Juan José Fernández Ávila
- Servicio de Farmacia Hospitalaria, Hospital Clínico Universitario Virgen de La Arrixaca, Murcia, Spain
| | - Alfonso Gómez-Iturriaga
- Servicio de Oncología Radioterápica, Hospital Universitario de Cruces, Instituto de Investigación Sanitaria Biobizkaia, Vizcaya, Spain
| | | | - Daniel Pérez Fentes
- Servicio de Urología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Gemma Sancho Pardo
- Servicio de Oncología Radioterápica, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Paula Gratal
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
| | | | - Vicente Guillem Porta
- Fundación ECO (Excelencia y Calidad de La Oncología), Madrid, Spain
- Servicio de Oncología Médica, Hospital Vithas 9 de Octubre, Valencia, Spain
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Yu P, Zhu C, You X, Gu W, Wang X, Wang Y, Bu R, Wang K. The combination of immune checkpoint inhibitors and antibody-drug conjugates in the treatment of urogenital tumors: a review insights from phase 2 and 3 studies. Cell Death Dis 2024; 15:433. [PMID: 38898003 PMCID: PMC11186852 DOI: 10.1038/s41419-024-06837-w] [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: 01/20/2024] [Revised: 06/08/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024]
Abstract
With the high incidence of urogenital tumors worldwide, urinary system tumors are among the top 10 most common tumors in men, with prostate cancer ranking first and bladder cancer fourth. Patients with resistant urogenital tumors often have poor prognosis. In recent years, researchers have discovered numerous specific cancer antigens, which has led to the development of several new anti-cancer drugs. Using protein analysis techniques, researchers developed immune checkpoint inhibitors (ICIs) and antibody-conjugated drugs (ADCs) for the treatment of advanced urogenital tumors. However, tumor resistance often leads to the failure of monotherapy. Therefore, clinical trials of the combination of ICIs and ADCs have been carried out in numerous centers around the world. This article reviewed phase 2 and 3 clinical studies of ICIs, ADCs, and their combination in the treatment of urogenital tumors to highlight safe and effective methods for selecting individualized therapeutic strategies for patients. ICIs activate the immune system, whereas ADCs link monoclonal antibodies to toxins, which can achieve a synergistic effect when the two drugs are combined. This synergistic effect provides multiple advantages for the treatment of urogenital tumors.
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Affiliation(s)
- Puguang Yu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Chunming Zhu
- Department of Family Medicine, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xiangyun You
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, 443002, China
- Department of Urology, Yichang Central People's Hospital, Yichang, 443002, China
| | - Wen Gu
- Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Xia Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yuan Wang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Renge Bu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
| | - Kefeng Wang
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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Yuan P, Xie Y, Xu R, Li Y, Yao K, Liu J, Yan B, Jiang S, Lu Q, Chen Q, Zang H, Xiong W, Tang Y, Hu S, Wang L. Efficacy of indocyanine green fluorescence-guided inguinal lymph node dissection for penile cancer: a randomised trial. BJU Int 2024; 133:442-450. [PMID: 37983593 DOI: 10.1111/bju.16231] [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] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To investigate the safety and efficacy of indocyanine green (ICG) fluorescence-guided inguinal lymph node dissection (ILND) in patients with penile cancer. PATIENTS AND METHODS A prospective, single-blind, randomised controlled clinical trial (ChiCTR2100044584) was performed among patients with penile caner who underwent bilateral modified ILND at four centres in China between 1 April 2021 and 30 June 2022. Patients aged 18-80 years and diagnosed with squamous cell carcinomas were included. Each enrolled patient was randomly assigned to either ICG fluorescence-guided ILND by a laparoscopic or robot-assisted approach in one groin, with non-ICG fluorescence-guided ILND in the other groin acting as a control. The primary outcome was the number of retrieved ILNs. Secondary outcomes included complications according to the Clavien-Dindo classification and the ILN non-compliance (inadequate removal of ILNs) rate. RESULTS A total of 45 patients were included in the intention-to-treat (ITT) analysis, and the 42 who completed the entire study were included in the per protocol (PP) analysis. There were no ICG-related complications in any of the patients. The results of the ITT and PP analyses indicated that the total number of unilateral ILNs retrieved was higher on the ICG side than on the non-ICG side (mean 13 vs 9 ILNs, difference 4 ILNs [95% CI 2.7-4.4], P = 0.007), and the number of unilateral deep and superficial ILNs was higher on the ICG side. Furthermore, the LN non-compliance rate was lower on the ICG side than on the non-ICG side. Additionally, there was no significant difference in local complications in the groins between the two sides (P > 0.05). CONCLUSION An ICG fluorescence-guided ILND was safe for patients with penile cancer. This procedure can improve the number of ILNs retrieved and reduce the LN non-compliance rate without increased complications. ICG fluorescence-guided ILND is beneficial and recommended for selected patients with penile cancer.
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Affiliation(s)
- Peng Yuan
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yu Xie
- Department of Urology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuanwei Li
- Department of Urology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Kun Yao
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jianye Liu
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Bin Yan
- Department of Urology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shusuan Jiang
- Department of Urology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Qiang Lu
- Department of Urology, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Qian Chen
- Department of Pathology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Hongjing Zang
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Xiong
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yongxiang Tang
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shuo Hu
- Department of Nuclear Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Long Wang
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
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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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10
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Bouabid M, Margoum S, BenSghier A, Miry N, Bennani A, Moukhlissi M, Berhili S, Mezouar L. Multimodal Therapy of Locally-Advanced Penile Cancer: A Case Report With Literature Review. Cureus 2024; 16:e57163. [PMID: 38681381 PMCID: PMC11056019 DOI: 10.7759/cureus.57163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/01/2024] Open
Abstract
Cancer of the penis is a rare tumor that occurs in the elderly. Because of its rarity, it is often not diagnosed early, and its treatment poses difficulties for practicing oncologists. We report the case of an elderly patient treated for locally advanced squamous cell carcinoma (SCC) of the penis, with a review of the literature. A 71-year-old man, who had been complaining of pruritus on the penis two years ago, presented with an ulcerated lesion on the prepuce and the glans. A biopsy of the lesion with pathological study showed a SCC of the penis. Pelvic MRI showed tumor thickening centered on the glans of the penis, infiltrating the fascia and the spongy urethra with discrete upstream dilatation and bilateral inguinal adenomegaly. CT scan of the neck, chest, abdomen, and pelvis showed no secondary localizations. Treatment initially consisted of carcinological surgery by a partial penectomy with bilateral inguinal lymph node dissection. The tumor was therefore classified as pT3N3M0. A PET CT scan performed later was in favor of local and regional recurrence. Surgery was not feasible, so concomitant chemo-radiotherapy was indicated at a total dose of 70 Gy in 35 fractions of 2 Gy concomitantly with platinum-based chemotherapy, withgood evolution.
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Affiliation(s)
- Meriem Bouabid
- Department of Radiation Oncology, Centre Hospitalier Universitaire Mohammed VI, Oujda, MAR
| | - Souad Margoum
- Department of Radiation Oncology, Centre Hospitalier Universitaire Mohammed VI, Oujda, MAR
| | - Ahmed BenSghier
- Department of Radiation Oncology, Centre Hospitalier Universitaire Mohammed VI, Oujda, MAR
| | - Nadir Miry
- Department of Pathology, Centre Hospitalier Universitaire Mohammed VI, Oujda, MAR
| | - Amal Bennani
- Department of Pathology, Centre Hospitalier Universitaire Mohammed VI, Oujda, MAR
| | - Mohamed Moukhlissi
- Department of Radiation Oncology, Centre Hospitalier Universitaire Mohammed VI, Oujda, MAR
| | - Soufiane Berhili
- Department of Radiation Oncology, Centre Hospitalier Universitaire Mohammed VI, Oujda, MAR
| | - Loubna Mezouar
- Department of Radiation Oncology, Centre Hospitalier Universitaire Mohammed VI, Oujda, MAR
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11
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Ionescu F, Nguyen J, Segura CM, Paravathaneni M, Grass GD, Johnstone P, Zacharias NM, Pettaway CA, Lu X, Kim Y, Whiting J, Dhillon J, Eschrich SA, Chadha J, Gullapalli K, Roman Souza G, Miyagi H, Manley BJ, Spiess PE, Chahoud J. Multiplex Immunofluorescence Captures Progressive Immune Exhaustion with Advancing Penile Squamous Cell Cancer Stage. Cancers (Basel) 2024; 16:303. [PMID: 38275860 PMCID: PMC10814242 DOI: 10.3390/cancers16020303] [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: 12/04/2023] [Revised: 12/25/2023] [Accepted: 01/05/2024] [Indexed: 01/27/2024] Open
Abstract
Penile squamous cell carcinoma (PSCC) is a rare and deadly malignancy. Therapeutic advances have been stifled by a poor understanding of disease biology. Specifically, the immune microenvironment is an underexplored component in PSCC and the activity of immune checkpoint inhibitors observed in a subset of patients suggests immune escape may play an important role in tumorigenesis. Herein, we explored for the first time the immune microenvironment of 57 men with PSCC and how it varies with the presence of human papillomavirus (HPV) infection and across tumor stages using multiplex immunofluorescence of key immune cell markers. We observed an increase in the density of immune effector cells in node-negative tumors and a progressive rise in inhibitory immune players such as type 2 macrophages and upregulation of the PD-L1 checkpoint in men with N1 and N2-3 disease. There were no differences in immune cell densities with HPV status.
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Affiliation(s)
- Filip Ionescu
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Jonathan Nguyen
- Pathology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | | | - Mahati Paravathaneni
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - G. Daniel Grass
- Radiation Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Peter Johnstone
- Radiation Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Niki M. Zacharias
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Curtis A. Pettaway
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Xin Lu
- Department of Biological Sciences, University of Notre Dame, Norte Dame, IN 46556, USA;
| | - Youngchul Kim
- Biostatistics and Bioinformatics Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Junmin Whiting
- Biostatistics and Bioinformatics Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Jasreman Dhillon
- Pathology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Steven A. Eschrich
- Biostatistics and Bioinformatics Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Juskaran Chadha
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Keerthi Gullapalli
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Gabriel Roman Souza
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Hiroko Miyagi
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Brandon J. Manley
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Philippe E. Spiess
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
| | - Jad Chahoud
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33612, USA; (F.I.); (M.P.); (J.C.); (P.E.S.)
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12
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Fahey CC, Nebhan CA, York S, Davis NB, Hurley PJ, Gordetsky JB, Schaffer KR. Metastatic Penile Squamous Cell Carcinoma Responsive to Enfortumab Vedotin. Int J Mol Sci 2023; 24:16109. [PMID: 38003302 PMCID: PMC10671469 DOI: 10.3390/ijms242216109] [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: 10/07/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Penile squamous cell carcinoma is a rare disease with very limited data to guide treatment decisions. In particular, there is minimal evidence for effective therapies in the metastatic setting. Here, we present a case of metastatic penile squamous cell carcinoma with response to the Nectin-4 inhibitor enfortumab-vedotin-ejfv (EV). EV was selected due to the evidence of the high expression of Nectin-4 in squamous cell carcinomas, including penile carcinoma. The patient had both radiographic and symptomatic improvement after two cycles of treatment, despite having been treated with multiple prior lines of traditional chemotherapy. This case provides support for the use of antibody-drug conjugates (ADC), including EV, in this disease with few other options in the advanced setting. Further studies examining Nectin-4 and ADCs in penile squamous cell carcinoma should be completed, as high-quality evidence is needed to guide treatment after initial progression for these patients.
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Affiliation(s)
- Catherine C. Fahey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (C.C.F.)
- Tennessee Valley Healthcare System, Veterans’ Affairs, Nashville, TN 37232, USA
| | | | - Sally York
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (C.C.F.)
- Tennessee Valley Healthcare System, Veterans’ Affairs, Nashville, TN 37232, USA
- Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Nancy B. Davis
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (C.C.F.)
- Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Paula J. Hurley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (C.C.F.)
- Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Jennifer B. Gordetsky
- Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Kerry R. Schaffer
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA; (C.C.F.)
- Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
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13
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Janes WCI, Johnston P, Organ M, Thoms J, Gaviolli E. The Utility of Salvage Radiotherapy for an Inoperable Inguinal Recurrence of Squamous Cell Carcinoma of the Penis. Cureus 2023; 15:e48815. [PMID: 38106763 PMCID: PMC10722349 DOI: 10.7759/cureus.48815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Penile cancer is a rare genitourinary malignancy for which limited treatment options exist beyond primary surgical resection. Metastatic lymphadenopathy represents a particularly poor prognosis with a lack of literature to suggest the effectiveness of radiation or systemic therapies. Our case documents an inguinal recurrence of penile squamous cell carcinoma not amenable to surgical intervention demonstrating complete response to salvage radiotherapy in the palliative setting. These observations propose the need for further research around the utility of radiotherapy in the management of metastatic penile malignancies.
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Affiliation(s)
- W C Ian Janes
- Medicine, Memorial University of Newfoundland, St. John's, CAN
| | - Paul Johnston
- Urology, Memorial University of Newfoundland, St. John's, CAN
| | - Michael Organ
- Urology, Memorial University of Newfoundland, St. John's, CAN
| | - John Thoms
- Radiation Oncology, Memorial University of Newfoundland, St. John's, CAN
| | - Eduardo Gaviolli
- Radiation Oncology, Memorial University of Newfoundland, St. John's, CAN
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14
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Yang S, Chang W, Zhang B, Hou Q, Zhang B, Kang Y, Yin Y, Wan J, Shang P. Development and validation of a predictive model for penile cancer based on the surveillance, epidemiology, and end results database and multi-center cases. J Cancer Res Clin Oncol 2023; 149:13665-13676. [PMID: 37522926 DOI: 10.1007/s00432-023-04784-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/15/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE Penile cancer (PC) is a great impact on the quality of life and psychological status of patients. This study aimed to construct nomograms using data from the Surveillance, Epidemiology, and End Results (SEER) database to predict overall survival (OS) and cancer-specific survival (CSS) in patients with penile cancer (PC). METHODS Patients were divided into a training cohort (n = 634) and a validation cohort (n = 272) in a 7:3 ratio. Independent risk factors influencing the prognosis of PC were screened using univariate and multivariate Cox analyses, and models for predicting PC were developed. Data from 203 patients with PC in four tertiary hospitals in Gansu Province from 2012 to 2021 were externally validated. RESULTS Univariate analysis and multivariate analysis showed revealed that the OS-related factors were age, grade, T stage, N stage, M stage and tumor size (p < 0.05); the CSS-related factors were age, mode of surgery, T stage, N stage, M stage and tumor size (p < 0.05). The C-indices of the OS and CSS nomograms in the training cohort were 0.743 [95% confidence interval (CI) (0.714-0.772)] and 0.797 (0.762-0.832), respectively. The C-indices of the OS and CSS nomograms in the internal validation cohort were 0.735 (0.686-0.784) and 0.755 (0.688-0.822), respectively, and those in the external validation cohort were 0.801 (0.746-0.856) and 0.863 (0.812-0.914), respectively. Receiver operating characteristic (ROC) curves, calibration curves, and survival curves all demonstrated good predictive performance of the nomograms. CONCLUSION The nomograms for PC were developed using the SEER database. The accuracy and clinical usefulness of the model were validated through a combination of internal and external validations.
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Affiliation(s)
- Shujun Yang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Wei Chang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Bin Zhang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Qian Hou
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Biao Zhang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Yindong Kang
- Department of Urology, The 940th Hospital of Joint Logistics Support Force of People's Liberation Army, Lanzhou, Gansu, China
| | - Yongsheng Yin
- Department of Urology, Gansu Provincial People's Hospital, Lanzhou, Gansu, China
| | - Jianghou Wan
- Department of Urology, First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Panfeng Shang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China.
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15
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Ermakov MS, Kashofer K, Regauer S. Different Mutational Landscapes in Human Papillomavirus-Induced and Human Papillomavirus-Independent Invasive Penile Squamous Cell Cancers. Mod Pathol 2023; 36:100250. [PMID: 37353203 DOI: 10.1016/j.modpat.2023.100250] [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: 01/12/2023] [Revised: 05/21/2023] [Accepted: 06/14/2023] [Indexed: 06/25/2023]
Abstract
Penile squamous cell carcinomas (SCC) are rare cancers that arise after transforming human papillomavirus (HPV) infections or independent of HPV in the background of chronic dermatoses. Limited knowledge about genetic alterations driving penile carcinogenesis comes from studies of mainly small cohorts of typically mixed etiology. In this comparative genetic study of HPV-induced and HPV-independent invasive penile SCC of 156 patients from a single institution in a low-incidence country, hotspots of 50 cancer-relevant genes were analyzed with targeted next-generation sequencing. Seventy-nine of 156 SCC were classified as HPV induced, and 77 of 156 SCC arose independent of HPV. Only 28 (35%) of 79 HPV-induced penile SCC, but 69 (90%) of 77 HPV-independent SCC carried somatic gene mutations. PIK3CA, FGFR3, and FBXW7 mutations occurred in both groups in similar numbers as seen in other human cancers. In contrast, mutations in TP53 (44/77; 57%), CDKN2A (35/77; 45%), and HRAS (13/77; 17%) genes occurred with one exception of a HIV positive patient exclusively in HPV-independent SCC with a frequent co-occurrence of TP53 and CDKN2A mutations (28/77; 42%). Mutations in multiple genes occurred in 9 (11%) of 79 HPV-induced SCC versus 47 (62%) of 77 HPV-independent SCC (χ2; P < .001). More than one mutation per gene (multi hits) was characteristic for HPV-independent SCC in 14 (18%) of 77 compared with only 3 (4%) of 79 HPV-induced SCC (χ2; P < .001). The total number of mutations in HPV-induced penile SCC (47 mutations) was significantly lower than that in HPV-independent SCC (143 mutations; Welsh test; P < .001). The presence of somatic driver gene mutations did not correlate with the age of patients, histology, or tumor stage of the primary SCC in either etiologic group, suggesting that acquisition of driver gene mutations is an early event after invasion. This large cohort analysis identified characteristic differences in mutational landscapes for the 2 etiologies. While genetic mutations in tumor suppressor genes drive HPV-independent penile carcinogenesis, oncogenic action of E6 and E7 substitute for mutations in HPV-induced SCC. A subgroup of patients with advanced SCC may be candidates for targeted therapy and clinical trials, although the majority of advanced penile SCC remain a therapeutic challenge.
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Affiliation(s)
- Mikhail S Ermakov
- Diagnostic and Research Institute of Pathology, Medical University Graz, MedCampus Graz, Graz, Austria
| | - Karl Kashofer
- Diagnostic and Research Institute of Pathology, Medical University Graz, MedCampus Graz, Graz, Austria.
| | - Sigrid Regauer
- Diagnostic and Research Institute of Pathology, Medical University Graz, MedCampus Graz, Graz, Austria.
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He Y, Mei J, Hao H, Liu F, Yi Y, Hu C, Zou F, Lu X. Selinexor demonstrates anti-tumor efficacy in paired patient-derived xenograft models and hydrogel-embedded histoculture drug sensitivity test of penile cancer. J Cancer Res Clin Oncol 2023; 149:6931-6941. [PMID: 36840755 DOI: 10.1007/s00432-023-04618-0] [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: 10/30/2022] [Accepted: 01/27/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND Penile cancer is a rare malignancy with a poor prognosis, even with various treatment options. Considering the little progress in the study of the pathogenesis and treatment of penile cancer because of the lack of models that mimic the biological properties of the tumor, we have developed a patient-derived xenograft (PDX) model and paired hydrogel-embedded histoculture drug sensitivity test (HDST) to screen for drugs that can inhibit tumors. The increased expression of XPO1, as a key nuclear export protein involved in the transport of various tumor suppressors and cell cycle regulatory proteins, is associated with the prognosis of a variety of tumors [World J Uroly 27(2):141-150, 2009]. Selinexor is an inhibitor of XPO1, which can treat cancers, such as multiple myeloma, gastric cancer, triple-negative breast cancer, and non-small cell carcinoma [Transl Androl Urol 6(5):785-790, 2017; OncoTargets Therapy 13:6405-6416, 2020]. However, whether XPO1 inhibition has a role in penile cancer remains unknown. Therefore, this article used the PDX and HDST models to investigate whether the inhibition of XPO1 has an effect on penile cancer and its underlying mechanism. METHODS We used penile cancer tumor tissues to construct a PDX model of penile cancer and paired PDXE model and confirmed the consistency of PDX tumor tissues in source patients. Then, we assessed the ability of Selinexor to inhibit penile cancer tissues in vivo using a PDX model and in vitro by HDST. We also examined the potential mechanism of XPO1 action on penile cancer by IHC and TUNEL. Finally, we assessed the safety of the drug treatment by H&E and biochemical blood analysis. RESULTS Result showed that the penile cancer PDX model and patient penile cancer tissues were clinically consistent in morphological characteristics and protein expression. In addition, Selinexor could inhibit tumor growth in PDX models and HDST. We found that P53, P21 expression was upregulated; Cyclin D1 expression was downregulated, and apoptosis of tumor cells was increased in the Selinexor-treated PDX model. Moreover, it had no significant effect on liver, kidney, and cardiac function. CONCLUSION The PDX model of penile cancer was a powerful tool for penile cancer research and new drug development. It showed that Selinexor can effectively inhibit penile cancer in vitro and in vivo. In addition, XPO1 may affect P53, P21, and Cyclin D1 expression to regulate the growth and apoptosis of penile carcinoma.
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Affiliation(s)
- Yuanqiao He
- Center of Laboratory Animal Science, Nanchang University, Nanchang, 330031, China
- Jiangxi Province Key Laboratory of Laboratory Animal, Nanchang, 330031, China
- Nanchang Royo Biotechnology, Nanchang, 330006, China
| | - Jiaqi Mei
- The First Clinical Medical College, Nanchang University, Nanchang University, Nanchang, 330031, China
| | - Hua Hao
- Department of Pathology, School of Medicine, Yangpu Hospital, Tongji University, Shanghai, 200090, China
| | - Fanrong Liu
- Department of Pathology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Yun Yi
- Center of Biobank, The Second Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Chao Hu
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Fangxing Zou
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330000, China
| | - Xiongbing Lu
- Department of Urology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330000, China.
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17
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Parza K, Mustasam A, Ionescu F, Paravathaneni M, Sandstrom R, Safa H, Grass GD, Johnstone PA, Eschrich SA, Chadha J, Zacharias N, Pettaway CA, Spiess PE, Chahoud J. The Prognostic Role of Human Papillomavirus and p16 Status in Penile Squamous Cell Carcinoma-A Systematic Review. Cancers (Basel) 2023; 15:3713. [PMID: 37509374 PMCID: PMC10378259 DOI: 10.3390/cancers15143713] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/11/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
PSCC is a rare cancer, with approximately half of all cases related to HPV. While HPV and p16 IHC testing have proven their prognostic value for oropharyngeal cancer, this is not yet established for PSCC. The current level of evidence exploring the relation between PSCC and HPV is moderate, so we conducted a systematic review following PRISMA guidelines to evaluate the prognostic role of HPV and p16 IHC in PSCC clinical outcomes. We searched the PubMed, Embase, and Cochrane databases and identified 34 relevant studies that met our inclusion criteria. Of these, 33 were retrospective cohort studies, and one was a cross-sectional study. Nine studies reported that HPV-positive and p16-positive PSCC had better overall survival (OS) and disease-free survival (DFS). This study highlights the need for a meta-analysis to determine the role of routine HPV status or p16 staining testing as part of the initial diagnosis and staging of PSCC patients worldwide.
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Affiliation(s)
- Kevin Parza
- Internal Medicine, USF Health Morsani College of Medicine, Tampa, FL 33601, USA
| | - Arfa Mustasam
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Filip Ionescu
- Internal Medicine, USF Health Morsani College of Medicine, Tampa, FL 33601, USA
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Mahati Paravathaneni
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Reagan Sandstrom
- Graduate Medication Education, USF Health Morsani College of Medicine, Tampa, FL 33602, USA
| | - Houssein Safa
- Hematology Oncology Department, Baylor College of Medicine, Houston, TX 77001, USA
| | - G Daniel Grass
- Radiation Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Peter A Johnstone
- Radiation Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Steven A Eschrich
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Juskaran Chadha
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Niki Zacharias
- Department of Urology, M.D. Anderson Cancer Center, University of Texas, Houston, TX 77001, USA
| | - Curtis A Pettaway
- Department of Urology, M.D. Anderson Cancer Center, University of Texas, Houston, TX 77001, USA
| | - Philippe E Spiess
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
| | - Jad Chahoud
- Genitourinary Oncology Department, H. Lee Moffitt Cancer Center, Tampa, FL 33601, USA
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18
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White J, Mason R, Lawen T, Spooner J, Faria KVM, Rahman F, Ramasamy R. Therapeutic Approaches to Penile Cancer: Standards of Care and Recent Developments. Res Rep Urol 2023; 15:165-174. [PMID: 37288454 PMCID: PMC10243351 DOI: 10.2147/rru.s387228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
Penile cancer is a rare malignancy, most commonly diagnosed in older men, associated with poor outcomes, dramatic decline in quality of life and sexual function. Squamous cell carcinoma is the most common histopathology of penile cancer, accounting for 95% of all cases. Localized, early-stage penile cancer can be effectively managed through penile-sparing techniques in many cases, though advanced stages of penile cancer carry a poor prognosis. Current innovative treatments are exploring the role of targeted therapy, HPV-directed therapy, immune checkpoint inhibitors and adoptive T-cell therapies in treatment and prevention of relapse of penile cancer. Clinical trials are investigating the potential of targeted therapies and immune checkpoint inhibitors in advanced penile cancer. This review examines the current management of penile cancer and highlights future directions in research and treatment.
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Affiliation(s)
- Joshua White
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ross Mason
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Tarek Lawen
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Jesse Spooner
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Kauy V M Faria
- Department of Urology, Institute of Cancer of São Paulo, University of São Paulo School of Medicine, Sao Paulo, Brazil
| | - Farah Rahman
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Akinyemi OA, Fasokun ME, Weldeslase TA, Adeoye O, Coleman PW. Influence of Race/Ethnicity and Household Median Income on Penile Cancer Mortality. Cureus 2023; 15:e40909. [PMID: 37496530 PMCID: PMC10366004 DOI: 10.7759/cureus.40909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/28/2023] Open
Abstract
INTRODUCTION Penile cancer, while relatively rare in developed nations, presents substantial disparities in outcomes among different demographic groups. Previous research has shown race/ethnicity and socioeconomic status, often proxied by household median income, to be critical determinants of health outcomes across various diseases. OBJECTIVE This study examines the association of race/ethnicity and household median income with survival among penile cancer patients in the United States. METHODS We utilized the Surveillance, Epidemiology, and End Results (SEER) Registry to identify patients with a primary diagnosis of penile malignancies from 2000 to 2019. Our primary outcome of interest was the hazard of death following a diagnosis of penile cancer. We utilized the Cox regression model to explore the association between race/ethnicity and median household income and how this influences survival among these patients. We adjusted for patients' characteristics, disease stage at presentation, and treatment modalities. RESULT Of the 6,520 penile cancer patients identified, 5,242 (80.4%) had primary malignancies. The distribution of patients was as follows: 64.1% non-Hispanic Whites, 8.9% non-Hispanic Blacks, 20.8% Hispanics, and 6.2% from other racial/ethnic groups. The median diagnosis age was 66 years (interquartile range: 56-74). Survival rates at 5, 10, and 15 years showed racial disparities: 76.4%, 72.5%, and 69.7% for non-Hispanic Whites; 70.6%, 64.1%, and 61.1% for non-Hispanic Blacks; and 70.5%, 67.4%, and 65.6% for Hispanics. Multivariate Cox regression revealed worst survival for Black (HR=1.40; 95% CI=1.08-1.81, p=0.01) and Hispanic patients (HR=1.24; 95% CI=1.01-1.52, p=0.04). No association was found between median household income and survival. Interaction analysis indicated that the poorest Black men had worse outcomes than the poorest Whites did (HR=2.08; 95% CI=1.27-3.41, p=0.003). CONCLUSION Survival rates for non-Hispanic Black and Hispanic patients are significantly lower than those for non-Hispanic Whites. Furthermore, survival is worse for low-income Black patients than their White counterparts in the same income bracket.
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Affiliation(s)
- Oluwasegun A Akinyemi
- Health Policy and Management, University of Maryland School of Public Health, College Park, USA
- Surgery, Howard University, Washington, DC, USA
| | - Mojisola E Fasokun
- Epidemiology and Public Health, University of Alabama at Birmingham, Birmingham, USA
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