Drug therapy for penile cancer

Drug therapy is sometimes used to treat penile cancer. The drugs can be given in different ways.

Drug therapy is given for different reasons. You may have drug therapy to:

• destroy cancer cells on the penis or in the body
• slow or stop the growth and spread of cancer
• shrink a tumour before surgery (called neoadjuvant therapy)
• destroy cancer cells left behind after surgery to reduce the risk that the cancer will come back (recur) (called adjuvant therapy)
• relieve pain or control the symptoms of advanced penile cancer (called palliative therapy)

Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of drug therapy. You may also receive other treatments.

Topical therapy uses a cream or gel to put drugs directly on the skin. The topical therapy drugs used for penile cancer are 5-fluorouracil (5-FU, Efudex) and imiquimod (Aldara).

5-fluorouracil is a chemotherapy drug used to treat a specific area on the penis. It is most often used to treat carcinoma in situ (CIS, or stage 0) or precancerous conditions of the penis. It is usually applied directly to the abnormal area each day for several weeks.

Imiquimod is a type of immunotherapy. It uses your immune system to help destroy cancer cells. It is most often used to treat carcinoma in situ or precancerous conditions of the penis. It is usually applied directly to the abnormal area a few times a week for several weeks. Find out more about immunotherapy.

Systemic chemotherapy uses anticancer (cytotoxic) drugs that travel through the blood to destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the penis. It is given through a needle into a vein (intravenous, or IV).

Systemic chemotherapy is usually used to treat more advanced penile cancers, such as penile cancer that has spread to the lymph nodes or distant parts of the body (stage 3 and stage 4). Chemotherapy given before surgery can reduce the size of the tumour. This makes it easier to remove the tumour from the penis. It also makes it easier to remove lymph nodes that have cancer. Chemotherapy may also be used after surgery to remove lymph nodes that have cancer, to destroy any cancer cells left behind and to reduce the risk that the cancer will come back. Chemotherapy may also be used to relieve pain or control the symptoms of advanced penile cancer. Chemotherapy drugs are given in 3-week to 4-week cycles. Each cycle is followed by a rest period so the body can recover. The most common systemic chemotherapy drugs used to treat penile cancer are:

• cisplatin
• 5-fluorouracil (Aducil, 5-FU)
• paclitaxel (Taxol)
• methotrexate
• ifosfamide (Ifex)
• mitomycin (Mutamycin)
• capecitabine (Xeloda)
• docetaxel (Taxotere)
• gemcitabine (Gemzar)
• irinotecan (Camptosar)
• pembrolizumab (Keytruda)

The most common chemotherapy drug combinations used to treat penile cancer are:

• cisplatin and 5-fluorouracil
• TIP – paclitaxel, ifosfamide and cisplatin
• cisplatin and irinotecan
• 5-fluorouracil and mitomycin
• vincristine (Oncovin) and methotrexate

Chemotherapy is sometimes combined with radiation therapy to treat penile cancer. This is called chemoradiation. The 2 treatments are given during the same time period.

Find out more about chemotherapy. Ask your healthcare team questions about chemotherapy.

Side effects can happen with any type of treatment for penile cancer, but everyone’s experience is different. Some men have many side effects. Other men have few or none at all.

Drug therapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after drug therapy. Sometimes late side effects develop months or years after drug therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of drug therapy will depend mainly on the type of drug, the dose, how it’s given (topical or intravenous) and your overall health. Common side effects of drug therapy used for penile cancer include the following.

Topical therapy may cause these side effects:

• red, itchy skin in the treated area
• burning and pain in the treated area
• swelling (edema)
• discharge from the wound

Systemic chemotherapy may cause these side effects:

• low blood cell counts( bone marrow suppression)
• weakened immune system
• increased chance of infection
• easy bruising and bleeding ( low platelet count)
• hair loss
• fatigue
• nausea and vomiting
• sore mouth and throat
• loss of appetite
• diarrhea
• nerve damage (neuropathy)
• skin problems
• kidney problems
• bladder problems

Tell your healthcare team if you have these side effects or others you think might be from drug therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

Details on specific drugs change regularly. Find out more about sources of drug information and where to get details on specific drugs.