Systematic Review and Meta-Analysis-Is there a Benefit in Using Neoadjuvant Systemic Chemotherapy for Locally Advanced Penile Squamous Cell Carcinoma?
| Autor: | Guru Sonpavde, Andrew Lai, Mounsif Azizi, Lance C. Pagliaro, Andrea Necchi, Ahmet M. Aydin, Charles C. Peyton, Jad Chahoud, Philippe E. Spiess, Ali Hajiran, Ambuj Kumar, Suks Minhas |
|---|---|
| Přispěvatelé: | Azizi, M., Aydin, A. M., Hajiran, A., Lai, A., Kumar, A., Peyton, C. C., Minhas, S., Sonpavde, G. P., Chahoud, J., Pagliaro, L. C., Necchi, A., Spiess, P. E. |
| Rok vydání: | 2020 |
| Předmět: |
Oncology
Male medicine.medical_specialty Urology medicine.medical_treatment Penile Neoplasm 030232 urology & nephrology Locally advanced Antineoplastic Agents 03 medical and health sciences 0302 clinical medicine Pharmacotherapy penile neoplasms systematic review Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Penile cancer Humans Penile Neoplasms Neoadjuvant therapy combination Chemotherapy business.industry Inguinal lymphadenopathy medicine.disease Neoadjuvant Therapy drug therapy meta-analysis Treatment Outcome Chemotherapy Adjuvant Meta-analysis Carcinoma Squamous Cell medicine.symptom Neoplasm Grading business |
| Zdroj: | The Journal of urology. 203(6) |
| ISSN: | 1527-3792 |
| Popis: | PURPOSE: Neoadjuvant chemotherapy is a recommended treatment for patients with penile cancer with bulky inguinal lymphadenopathy or unresectable primary tumors, although there is no evidence of its benefit from randomized trials. MATERIALS AND METHODS: We conducted a systematic search in Embase® and MEDLINE® for studies reporting on patients who received preoperative neoadjuvant chemotherapy for locally advanced penile squamous cell carcinoma. Objective response rate, pathological complete response, grade 3 or greater toxicity and overall mortality were evaluated in terms of neoadjuvant chemotherapy type, which was dichotomized as nontaxane-platinum and taxane-platinum regimens. RESULTS: Overall 10 studies met the inclusion criteria, enrolling a total of 182 patients, with 66 (36.3%) and 116 (63.7%) treated with nontaxane-platinum and taxane-platinum regimens, respectively. The pooled results demonstrated an objective response rate of 53% (95% CI 42-64), pathological complete response rate of 16%, grade 3 or greater toxicity rate of 40% (95% CI 19-64) and overall mortality of 55% (95% CI 40-70) in patients treated with neoadjuvant chemotherapy. Stratified subanalysis revealed an objective response rate of 55% and 49%, a pathological complete response of 9% and 20%, a toxicity rate of 26% and 49%, and an overall mortality of 54% and 58% for nontaxane-platinum vs taxane-platinum regimens, respectively. CONCLUSIONS: The pooled findings in this study suggest that approximately 50% of the patients with bulky regional lymph node metastases from penile cancer respond to platinum based neoadjuvant chemotherapy and approximately 16% of patients achieve a pathological complete response. Nontaxane based regimens appear to be better tolerated than taxane regimens based on reported grade 3 or greater adverse events (26% vs 49%). Ultimately the robustness of these observations should be interpreted with an awareness of the inherent limitations of deriving data from a collection of small, heterogeneous series. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|