Durvalumab合併化學治療或將第四期陰莖鱗狀上皮癌轉為可切除疾病-案例報告

曾浩翔¹、林精湛^2,3、林哲弘²、楊啟瑞¹

¹中國醫藥大學附設醫院 泌尿部; ²中國醫藥大學附設醫院 血液腫瘤科; ³中國醫藥大學 安南醫院 血液腫瘤科

Combination of durvalumab and chemotherapy potentially convert unresectable stage IV penile squamous cell carcinoma to resectable disease: A case report

Hao Xiang Chen ¹ , Ching-Chan Lin ^2,3 , Che-Hung Lin ² , Chi-Rei Yang ¹

¹ Department of Urology, China Medical University Hospital; ² Division of Hematology and Oncology, Department of Internal Medicine; ³ Division of Hematology and Oncology, Department of Internal Medicine, An Nan Hospital, China Medical University

Introduction: Penile squamous cell carcinoma(PSCC) is a rare disease entity with poor overall survival in an advanced stage, The literature about the role of immunotherapy in advanced penile squamous cell carcinoma is limited. In this report, we present a case of large tumor burden metastatic penile cancer with concomitant anal SCC that showed a dramatic response to the combination of durvalumab and chemotherapy(cisplatin and 5-FU).

Case presentation: The patient is a 64 years old man with well-controlled human immunodeficiency virus infection for 20 years, and syphilis. He was diagnosed to have squamous cell carcinoma of the penis 3 years ago. Abdominal computed tomography (CT) and chest CT showed lymphadenopathy of bilateral inguinal lymph nodes. The patient refused penectomy because he was concerned about the loss of sexual function. The patient had not returned for continued care until he suffered from difficult voiding, pain, and bleeding 3 years later after his first evaluation. Physical examination showed the tumor involved the anus, perianal region, penis, and perineum. Besides, multiple fixed, bilateral palpable inguinal lymph nodes were also noted. CT showed multiple retroperitoneal lymphadenopathies, bilateral inguinal lymphadenopathy, anal tumor, and penile tumor, the TNM staging was cT3N3M1. The patient received systemic therapy durvalumab 240mg, cisplatin 100mg, and 5-fluorouracil 2000mg every 2 weeks for 6 cycles. The patient’s treatment course has been smooth without significant adverse events. After 6 cycles of durvalumab and chemotherapy combination therapy, the size of the bilateral inguinal lymph node and the anal protruding mass shrank dramatically on examination with a CT scan (Figure 2B, E, H). Externally, no visible tumor mass could be seen in the genital area and perianal region(Figure 1B). The physical examination at this time showed only one palpable left inguinal lymph node. The disease had become potentially resectable with staged operation planning at this moment but the patient refused further surgery. The patient was further treated with chemotherapy and radiation therapy.

Conclusion: Our case demonstrated that the combination of durvalumab and chemotherapy can be very effective in the systemic therapy setting of unresectable PSCC and has the potential of converting the unresectable penile SCC to a resectable and curable disease. Further clinical trials of the combination of immunotherapy and chemotherapy are warranted.