Abstract 755P
Background
Penile cancer (PeCa) is a rare but aggressive malignancy. Despite surgical interventions, men who present with locally advanced disease have a relatively high risk of treatment failures with local and distant metastases. Adjuvant chemotherapy (ACT) may be of value in mitigating some of this risk, but large comparative or randomized trials are lacking. Neoadjuvant chemotherapy (NACT) in PeCa has been trending over time as it serves as cytoreductive approach to make surgical resection more feasible. However, there are no direct comparisons between these chemotherapy approaches concerning clinical efficacy. The purpose of this proportional meta-analysis is to compare death rates and recurrence rates of NACT versus ACT in locally advanced PeCa.
Methods
A review of the medical literature was conducted using online databases. Inclusion criteria were English language; case series with more than 4 cases; patients with locally advanced PeCa treated with ACT or NACT; and studies documenting clinical outcomes of interest: death rates, recurrence rates, and NACT response rates. Proportional meta-analysis was conducted using the random-effects model.
Results
Eighteen case series (12 NACT with 371 participants, 6 ACT with 181 participants) were included in this proportional meta-analysis. The NACT pooled proportion of death rates (DR), recurrence rates (RcR), and response rates (RR) were 58% (95%CI:52-64), 51% (95%CI:37-65), 52% (95%CI:46-59) respectively. The ACT pooled proportions of DR and RcR were 37% (95%CI:24-48) and 46% (95%CI:38-54) respectively. There was a significant difference with respect to DR but not RcR between NACT and ACT.
Conclusions
This is the first proportional meta-analysis in locally advanced PeCa to show that NACT is associated with higher death rates but not recurrences when compared to ACT. This finding may be the result of increased toxicity of NACT as it interacts with surgical morbidity and mortality. It may also be the result of an inherent selection bias where higher risk locally advanced PeCa are prescribed NACT in attempt to enhance surgical resectability and outcome.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Philip A. Haddad.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.