levoleucovorin and Penile-Neoplasms

Eight patients with epidermoid carcinoma of the penis received methotrexate, five with high-dose methotrexate, 250--1500 mg/m2 with citrovorum rescue Q 2--4 weeks, and three with low-dose methotrexate, 0.5--3.0 mg/kg weekly. Three (38%) patients achieved a complete or partial remission which persisted for 11, 3 and 2 months, respectively. Methotrexate appears to be an active agent in the treatment of advanced penile cancer.

Topics: Adult; Aged; Carcinoma, Squamous Cell; Clinical Trials as Topic; Drug Therapy, Combination; Humans; Leucovorin; Male; Methotrexate; Middle Aged; Penile Neoplasms; Remission, Spontaneous; Time Factors

Limited literature on the role of intraarterial chemotherapy as first-line therapy for penile squamous cell carcinoma is available.. From 2005 to 2013, a total of 12 patients with various stages of penile squamous cell carcinoma received intraarterial chemotherapy. The chemotherapeutic agents used were methotrexate, mitomycin C, bleomycin, cisplatin, and 5-fluorouracil. Surgery was followed by the tumour responses.. An objective tumour response was noted in 10 of 12 patients (83%, 4 complete responders and 6 partial responders). In node-negative patients (n=7), the response rate was 100% (4 complete responders and 3 partial responders). Even in advanced penile squamous cell carcinoma with nodal invasion, a response rate of 60% could be achieved. Grade 2 anorexia was the most frequent chemotherapy-related toxicity and no toxic death was noted. Recurrence-free survival was significantly better in patients without lymph node invasion (log-rank test, P=0.041).. Neoadjuvant intraarterial chemotherapy displayed excellent responses for penile squamous cell carcinoma. This therapy could effectively shrink the tumour burden or even achieve complete response before surgery. It could be used as first-line strategy for penile cancer treatment because of low toxicity.

Topics: Adult; Aged; Aged, 80 and over; Anorexia; Antineoplastic Combined Chemotherapy Protocols; Bleomycin; Carboplatin; Carcinoma, Squamous Cell; Chemotherapy, Adjuvant; Cisplatin; Disease-Free Survival; Fluorouracil; Humans; Infusions, Intra-Arterial; Inguinal Canal; Leucovorin; Lymph Node Excision; Lymphatic Metastasis; Male; Methotrexate; Middle Aged; Mitomycin; Neoadjuvant Therapy; Penile Neoplasms; Retrospective Studies

Traditional treatment for advanced penile verrucous carcinoma is penectomy. This mostly leads to remarkable psychosexual problems and greatly affects quality of life, especially in young patients. To preserve the penis we used intra-aortic infusion chemotherapy for advanced verrucous carcinoma.. From 1991 to 2009 we treated 6 men with penile verrucous carcinoma with continuous intra-aortic infusion of 50 mg methotrexate every 24 hours (average 550 mg, range 400 to 800). Citrovorum factor (6 mg) was given intramuscularly every 6 hours during methotrexate infusion. After continuous methotrexate infusion no further anticancer drug was given to complete responders. Partial responders subsequently received long-term, intermittent, intra-aortic infusion of 50 mg methotrexate or 2 mg mitomycin C plus 250 mg 5-fluorouracil every 1 to 2 weeks until tumors disappeared and all wounds healed.. After treatment 4 patients achieved a complete response and were disease-free 3 years 9 months to 17 years 10 months (median 11 years 3 months) after therapy. Two patients had a partial response. The patient with a shaft tumor subsequently underwent total penectomy due to unbearable penile pain 4 years after infusion with various drugs without an appreciable response. He has survived 12 years 5 months after initial treatment. The other patient with glans and prepuce tumors had progression with bilateral inguinal metastases despite 1 1/2 years of infusion therapy. Total penectomy was done. Histological examination of the glans mass revealed moderately differentiated squamous cell carcinoma. Patient condition progressed rapidly and he died 11 months after penectomy.. Intra-aortic infusion chemotherapy is a simple, effective method to treat penile verrucous carcinoma with the uniqueness of preserving the anatomical structure and sexual function in complete responders. For penile verrucous carcinoma, especially in younger patients, intra-aortic infusion chemotherapy may be considered organ sparing treatment before penectomy.

Topics: Adult; Aged; Antimetabolites, Antineoplastic; Aorta, Abdominal; Carcinoma, Verrucous; Fluorouracil; Humans; Infusions, Intra-Arterial; Leucovorin; Male; Methotrexate; Middle Aged; Mitomycin; Penile Neoplasms; Treatment Outcome; Vitamin B Complex

Despite of its rich vascularization and extensive circulatory communication with neighboring organs, penile metastases are rare. Even more infrequent is a penile metastasis of rectum tumors. Since the first report of rectal carcinoma with metastasis to the penis (Ehbert 1870), approximately 50 cases have been reported, most of them from the USA, the remaining from Western Europe, the Middle East and Japan. The first Hungarian case is reported now of penile metastasis of a rectal carcinoma. The case of a 65-year-old man is presented: isolated penile metastasis discovered 4.5 years after the primary rectal cancer resection. IHC tissue diagnosis and detailed clinical investigations confirmed metastatic rectal adenocarcinoma. As our patient refused penectomy and KRAS mutation was proven, FOLFIRI chemotherapy was initiated without cetuximab. This was followed by chemoradiotherapy that resulted only in transient regression. Currently the patient receives the FOLFOX regimen. At present the patient is in good performance status,without pain. The size and the number of penile metastases have not shown significant changes. According to the literature the average survival of patients with penile metastases treated with radiochemotherapy is 8 months. New chemotherapeutic modalities may improve the survival.

Topics: Adenocarcinoma; Aged; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Camptothecin; Cetuximab; Chemotherapy, Adjuvant; Diagnosis, Differential; Fluorouracil; Humans; Leucovorin; Male; Neoplasm Recurrence, Local; Neoplasms, Second Primary; Organoplatinum Compounds; Palliative Care; Penile Neoplasms; Radiotherapy, Adjuvant; Rectal Neoplasms; Treatment Outcome

A case of extensive metastatic epidermoid carcinoma of the penis is reported. Disseminated disease developed after penectomy and lymphadenectomy and it continued to progress while the patient received radiation therapy. Chemotherapy with high dose methotrexate followed by citrovorum factor rescue was instituted. After completion of 10 weekly cycles of treatment there was biopsy-proved complete regression of all lesions, which lasted 9 months when the patient suddenly died of pneumonia completely unrelated to the tumor or chemotherapy treatment. This chemotherapeutic approach deserves additional trial in patients with advanced stages of penile carcinoma.

Topics: Carcinoma, Squamous Cell; Humans; Leucovorin; Male; Methotrexate; Middle Aged; Neoplasm Metastasis; Penile Neoplasms