Introduction: The side effect profiles of topical chemotherapeutics have been well-characterized in extra-genital squamous cell carcinoma; however, due to the rarity of the disease, there is limited data regarding the use of topical agents for non-invasive penile squamous cell carcinoma (CIS). We aim to describe the acute toxicities and compliance associated with topical 5-fluorouracil (5-FU) and imiquimod (IQ) in patients with penile CIS.
Methods: We performed a retrospective review of all cases of penile CIS treated with first-line topical chemotherapy from 2009 to 2019 at a tertiary care center.
Results: Over a 10-year period, a total of 20 patients with penile CIS were treated with either 5-FU (n = 17, 85%) or IQ (n = 3, 15%). The mean age was 61 (27-78) years. The mean follow-up was 23 months. Complete response (CR) was achieved in 65% (n= 13/20), partial response (PR) in 25% (n = 5/20), and no response (NR) in 10% (n = 2/20). Overall, 50% (n = 10/20) required additional alternative treatments due to lack of CR or relapse, which included wide local incision (70%), laser ablation (20%), and partial penectomy (10%). The mean recurrence free survival (RFS) was 13 months. Fifty percent (n = 10/20) of patients reported acute toxicity, including local skin irritation (40%), pain (35%), dysuria (5%), or nausea (5%). Only 65% (n=13/20) completed the full course of treatment as prescribed. Patients who received incomplete treatment had a CR of 28.6% (n = 2/7).
Conclusions: Topical chemotherapy is a moderately effective first-line therapy for penile CIS. A significant proportion of patients experienced acute toxicity and were unable to complete the full course of therapy. We recommend that patients with penile CIS should be monitored regularly in order to promptly address issues with adherence and toxicity associated with topical treatment. Source of
