Cisplatin, Methotrexate and Bleomycin for Advanced Recurrent or Metastatic Penile Squamous Cell Carcinoma

Objective: This study aimed to evaluate the efficacy and toxicity of cisplatin, methotrexate, and bleomycin (CMB) chemotherapy in patients with advanced, recurrent, or metastatic penile squamous cell carcinoma (PSCC). Methods: The CMB regimen was administered to 12 patients with advanced (n=7), recurrent (n=4), or metastatic (n=1) PSCC. Patients received a total of 21 cycles of CMB between 2002 and 2009, and were retrospectively reviewed for treatment efficacy and toxicity of the drugs. The mean patient age was 61 (61.0 ± 8.7) years. Patients received 20.0 mg/m2 of cisplatin intravenously on days 2-6; 200.0 mg/m2 of methotrexate intravenously on days 1, 15 and 22; and 10.0 mg/m2 of bleomycin as a bolus on days 2-6. The CMB regimen consisted of 21-28 days of treatment per cycle. Survival after CMB therapy and frequency and magnitude of adverse effects were assessed. Results: Of the 7 patients with advanced disease who received the CMB regimen as neoadjuvant and/or adjuvant treatment, 5 survived, 1 died of local recurrence and lung metastasis, and 1 died of interstitial pneumonia. Three of the 5 patients with recurrent or metastatic disease died of PSCC. One patient died of interstitial pneumonia due to CMB. Only 1 patient with inguinal lymph node metastasis after penectomy who underwent adjuvant CMB regimen had survived. Eight patients who were disease free survived longer than those who still had the disease. No adverse hematological effects of Grade 3 or higher were observed. Conclusion: The CMB regimen might be effective for advanced PSCC, but not for recurrent or metastatic PSCC. Two patients died of interstitial pneumonitis due to chemotherapy. Hence, we believe that the CMB regimen should not be used as a first-line treatment option in patients with advanced-stage or metastatic PSCC.