Penile Cancer – new hope for a rare male cancer
This Movember let’s not forget the sufferers of the other male cancers, that don’t often manage to share the spotlight with prostate and testicular cancer.
This month men up and down the country are doing their best to grow moustaches for Movember, the charity which raises funds and awareness for men’s health issues. Movember also funds research conducted here at The Institute of Cancer Research, London, such as Dr Clare Turnbull’s important study identifying new familial genetic causes of testicular cancer. This work will hopefully improve diagnosis and management for patients with the condition, but what about other cancers that afflict men?
Compared with big killers like prostate, lung and bowel cancer, cancer of the penis accounts for just 0.3% of men who develop cancer. Fewer than 550 men are diagnosed with penile cancer in the UK every year, and this rarity means that a urologist may only see one case a year. As a result, little is known about what is the most effective treatment.
There are very few drugs available to tackle penile cancer, and still one of the most common treatment options is surgery, including amputation; a distressing prospect for any man.
To find more effective options than surgery, new treatments must be rigorously tested in clinical trials, but for such a rare disease gathering enough patients to perform trials can be a long and laborious process.
But a penile cancer trial published recently in the British Journal of Cancer, carried out by The Institute of Cancer Research (ICR) and the University Hospitals Bristol NHS Foundation Trust, on behalf of the NCRI Penile Cancer Subgroup, has demonstrated that trials can be run in this rare disease.
It was the first UK trial for patients with penile cancer in 20 years and was only possible due to a reorganising of cancer services in the UK. On the advice of NICE, ten nationwide supra-regional networks were set up to manage penile cancer treatment; their formation also facilitated efficient collaborative research allowing patients from across the country to participate in the trial. 26 patients were recruited in just over a year; the only other similar sized trial in recent years, conducted in Italy, took eight years to recruit..
The trial (funded by Cancer Research UK, CRUK/09/001) was testing a type of chemotherapy called TPF, which compliments two chemotherapy drugs with a drug called docetaxel, to see if it could be beneficial to penile cancer patients. At the moment, patients may receive the drugs cisplatin and 5-flurouracil (PF), but there is very little scientific evidence to say if it actually benefits penile cancer patients; in fact, despite the treatment being in use since 1990, its effects have only ever been reported in 19 men.
Unfortunately, the trial found that TPF chemotherapy was not a promising treatment option. While two patients saw their cancers go into remission, only 10 out of 26 patients on the trial displayed a measurable response to TPF (39%) and 19 patients suffered serious side-effects (66%).
Although this outcome may seem disappointing, there are positives that can be taken away. For rare cancers like penile cancer, a negative result can be as important as a positive result. It allows researchers to focus on the treatments that are most effective and ensures that the best available evidence guides clinical practice.
This trial also shows that it’s possible to conduct research into rare cancers quickly and get the evidence needed to make better decisions on medical treatment.
The NCRI Penile Cancer Subgroup and the ICR Clinical Trials and Statistics Unit are now collaborating on more trials in this disease, including the VinCaP trial (CRUK/12/021), which will investigate the effectiveness of another chemotherapy treatment called vinflunine. A new international trial, InPACT, is also being set-up. Led by the ICR’s Clinical Trials and Statistics Unit (ICR-CTSU) and run under the backing of the International Rare Cancers Initiative, it is hoping to recruit 400 penile cancer patients from the UK, Europe and US for the largest penile cancer trial ever.
The study will examine the benefit of standard treatments for penile cancer, providing an evidence basis on which to test newer interventions, including the place of targeted therapy in penile cancer management. So there’s plenty of hope that this rare cancer will see better treatments coming soon.