Neoadjuvant paclitaxel, ifosfamide and cisplatin (TIP) for penile cancer with bulky lymph node metastases
Giving three drugs before surgery to men with penile cancer that had spread to bulky groin or pelvic nodes shrank the cancer in half of them and allowed some to be cured, and TIP became the standard chemotherapy for node-positive penile cancer.
Overview
Single-centre phase 2 study of 30 men with penile squamous cell carcinoma and bulky regional lymph node metastases (N2 to N3) treated with four cycles of paclitaxel, ifosfamide and cisplatin followed by lymphadenectomy where feasible.
Half of the patients had an objective response, 22 went on to surgery and three had no viable tumour in the resected nodes. Response to chemotherapy and absence of extranodal extension or bilateral disease at surgery predicted survival.
- Objective response in 15 of 30 patients (50 percent) to neoadjuvant TIP.
- 22 patients proceeded to lymphadenectomy; three had a complete pathological response.
Neoadjuvant TIP followed by surgery is the standard approach to bulky node-positive penile cancer in guidelines, though its randomised test against surgery first is the InPACT trial.
- Single-arm study of 30 patients at one centre.
- Most patients still relapsed; long-term survival remained poor.
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