Immunotherapy in the Scenario of Cancer of the Penis an Update

Penile cancer or carcinoma of the penis is an uncommon malignant tumour of the penis which usually relates to penile squamous cell carcinoma (PSCC), that amounts to for more than 95% of all penile malignancies. Despite the fact that organ-sparing surgery is an effective treatment option for early-stage PSCC, surgical intervention alone is known often not to be curative for advanced PSCC with metastases to the inguinal and/or pelvic lymph nodes; in view of this systemic therapy is usually necessitated and this usually entails administration of platinum-based chemotherapy and surgery combined. Nevertheless, it has been realised that chemotherapy for PSCC had proven to be of limited efficacy and is often ensued by high toxicity, and patients with advanced PSCC usually portend poor prognosis. The limited treatment options and poor prognosis indicate the unmet need for advanced PSCC. Immune-based treatments had been approved for administration in various genitourinary and squamous cell carcinomas but they had been rarely reported in PSCC. Many studies had reported high expression of PDL1 in PSCC, which had been in the support of the potential application of immune checkpoint inhibitors in PSCC. In addition, human papillomavirus (HPV) infection is highly prevalent in PSCC and plays a pivotal role in the carcinogenesis of HPV-positive PSCC, indicating that therapeutic HPV vaccine might also be a potential treatment option. Furthermore, adoptive T cell therapy (ATC) had also demonstrated efficacy in treating advanced penile cancer in some early clinical trials. The development of new treatments relies upon the understanding of the underlying biological mechanisms and processes of tumour initiation, progression and metastasis. Immunotherapy has been reported in some scenarios to have improved the outcome of some reported cases of penile carcinoma. Immunotherapy is only available for the treatment of penile cancer in some developed countries and research centres but not in most developing country urology and oncology units. It would therefore be envisaged that majority of clinicians in the world would tend not to be familiar with utilisation of immunotherapy in the treatment of penile cancer. The ensuing article on immunotherapy in the scenario of penile cancer is divided into two parts: (A) Overview of immunotherapy, and (B) Miscellaneous narrations and discussions from some case reports, case series and studies related to penile cancer.