Neoadjuvant chemotherapy for lymph node-positive penile cancer: current evidence and knowledge

To review the latest in penile cancer treatment focusing on neoadjuvant chemotherapy in patients with regional lymph node involvement.

Patients with regional lymph node involvement from penile cancer still suffer from a poor prognosis, and the chances to achieve cure are primarily dependent on the extent of the disease. Despite multiple lines of research are indicating the need for a multimodal management of the disease upfront, the search for newer effective systemic therapies is ongoing. The available guidelines currently suggest the use of combination chemotherapy regimens including taxanes and cisplatin as induction therapy before lymphadenectomy in patients with locally advanced disease (i.e., fixed or bulky inguinal lymph nodes or pelvic lymph node involvement). Research in the field will aim to provide more effective systemic therapies also in patients with a more limited disease spread to further improve the outcomes. Data from the literature also indicate the possibility to effectively administer postoperative chemotherapy in selected high-risk patients.

We aimed to provide the evidence from the literature and the new avenues that would help delineating the optimal therapeutic pathway for these complex patients, commenting on the new opportunities that may come from the ongoing research.