ESMO Guidelines for Penile Cancer
Management Exam Questions with
100% Correct Answers
What is the recommendation for the management of patients with high-risk node-
positive disease? - Answer-Adjuvant treatment should be considered as a tool in post-
operative management.
What is the recommended initial treatment for biopsy-proven PeIN located on the glans
or prepuce? - Answer-Circumcision is recommended as the initial treatment.
What alternative treatment can be used for residual PeIN besides topical agents? -
Answer-CO2 laser ablation can be used.
What is the typical external beam radiation therapy (EBRT) course for penile cancer? -
Answer-66-74 Gy in 2 Gy fractions, five times per week.
What are the recommended doses for low-dose rate (LDR) and high-dose rate (HDR)
brachytherapy in penile cancer treatment? - Answer-LDR: 60-65 Gy continuously; HDR:
35 Gy in nine fractions over 5 days.
What is the recommended treatment for low-volume residual disease in penile cancer? -
Answer-38.4 Gy in 12 fractions.
What is the most frequently proposed radiation schedule for intact tumors in penile
cancer? - Answer-42-45 Gy in 12-14 fractions.
What surgical procedure is recommended for lesions involving the glans? - Answer-
Wide local excision or glans resurfacing with reconstruction using SSG or penile shaft
skin.
When is Mohs micrographic surgery considered for penile lesions? - Answer-For low-
grade penile lesions (T1) if the right clinical setup is available.
What should be considered for patients with cN3 fixed nodes in penile cancer? -
Answer-Neoadjuvant chemotherapy with triplet regimens such as TIP or TPF.
,What is recommended for T2 tumors of the glans penis? - Answer-Glansectomy with or
without distal urethrectomy and SSG reconstruction.
What treatment options are available for patients with disease progression or
unresectable lymph nodes? - Answer-Additional systemic chemotherapy, local-field
radiation therapy, or participation in a clinical trial.
What is the recommended adjuvant treatment for patients with pN3 disease? - Answer-
Adjuvant radiation therapy with at least 50 Gy in 2 Gy fractions or a biological equivalent
dose.
What is the median overall survival (OS) for patients with metastatic penile SCC after
first-line chemotherapy failure? - Answer-Median OS is only 6-8 months.
What combination chemotherapy regimens are recommended for first-line treatment of
metastatic disease? - Answer-Cisplatin plus 5-FU, carboplatin plus paclitaxel, TIP, and
TPF.
What is the median OS associated with second-line treatment using single-agent
paclitaxel? - Answer-Median OS of 23 weeks.
What was the median OS reported for second-line treatment with epidermal growth
factor receptor-targeted therapy? - Answer-Median OS of 29.6 weeks.
What challenges do inoperable cases of recurrent penile cancer present? - Answer-
Inoperable cases present challenges for palliation and wound management.
What is the role of molecular profiling in the treatment of penile cancer? - Answer-
Molecular profiling can guide treatment decisions, especially in recurrent disease.
What is the significance of the Eastern Cooperative Oncology Group (ECOG)
performance status in treatment decisions? - Answer-ECOG performance status helps
determine the suitability of patients for specific chemotherapy regimens.
What is the recommended approach for managing recurrent disease at the primary
tumor site? - Answer-Further surgery can help palliate these patients when feasible.
What is the role of systemic therapy in the second-line setting for metastatic penile
cancer? - Answer-There are very limited data, but single-agent therapies like paclitaxel
have been used.
What are the management options for recurrent disease on the glans without corpus
cavernosum invasion? - Answer-Wide local excision, distal corporectomy, or
brachytherapy in selected cases.
,What surgical options may be required for more extensive disease involving the corpus
cavernosum? - Answer-Partial or total penectomy.
What is the role of palliative chemotherapy (ChT) in metastatic penile cancer? - Answer-
It is used to improve symptoms and prolong life.
What is the classical backbone of therapy for metastatic penile cancer? - Answer-
Platinum-based chemotherapy.
What are some commonly utilized chemotherapy regimens for metastatic penile
cancer? - Answer-Cisplatin with 5-FU and platinum with taxane.
What is the median progression-free survival (PFS) for cisplatin and 5-FU in penile
cancer treatment? - Answer-20 weeks.
What is the median overall survival (OS) reported for cisplatin and 5-FU in penile cancer
treatment? - Answer-8 months.
What response rates have been associated with chemotherapy regimens in penile
cancer? - Answer-Partial response or clinical benefit rates of 20%-40%.
What was the response rate reported in a UK study using the TPF regimen for penile
cancer? - Answer-38%.
What toxicity rate was observed in the TPF regimen study? - Answer-63% for grade 3-4
toxicity.
What was the response rate for the TIP regimen used as neoadjuvant treatment for
inoperable disease? - Answer-Approximately 50%.
What is the clinical benefit rate reported for the vinca alkaloid vinflunine in penile
cancer? - Answer-45%.
What response rate was reported in a phase II study of the HER tyrosine kinase
inhibitor dacomitinib? - Answer-33%.
What is the significance of programmed death-ligand 1 (PD-L1) in penile squamous cell
carcinoma (SCC)? - Answer-It may be amenable to therapeutic intervention with PD-L1-
targeted immunotherapies.
What is the FDA-approved anti-PD-L1 agent for patients with cutaneous, inoperable
SCC? - Answer-Cemiplimab.
What response rate was reported from the phase II trial of cemiplimab? - Answer-47%.
, What was the median overall survival (OS) in the PERICLES trial for advanced penile
SCC? - Answer-11.3 months.
What was the response rate in the PERICLES trial for atezolizumab treatment arms? -
Answer-16.7%.
What is the overall disease control rate reported in the GSRGT retrospective study for
metastatic penile cancer? - Answer-35%.
What should be considered for patients with no response or disease progression after
initial treatment? - Answer-Second-line systemic chemotherapy or radiotherapy for local
control, best supportive care, or a clinical trial.
What is recommended for local control in the presence of metastatic inoperable
disease? - Answer-Palliative radiotherapy or radiotherapy with concurrent
chemotherapy.
What factors may allow for the use of anti-PD-L1 immunotherapy in selected patients? -
Answer-High tumor mutational burden (TMB), microsatellite instability-high (MSI-H), or
mismatch repair deficiency (dMMR).
What is the importance of biomarker-selected clinical trials in penile cancer treatment? -
Answer-They should be considered where available.
What is the significance of high TMB and MSI-H in cancer treatment? - Answer-High
Tumor Mutational Burden (TMB) and microsatellite instability-high (MSI-H) status are
associated with positive responses to immunotherapy, such as pembrolizumab, in
patients with unresectable or metastatic solid tumors.
What is the FDA approval status of pembrolizumab? - Answer-Pembrolizumab has FDA
approval for use in a tumor-agnostic setting based on responses seen in patients with
unresectable or metastatic MSI-H or mismatch repair deficient (dMMR) solid tumors.
What are the potential benefits of immunotherapy in penile cancer? - Answer-
Immunotherapy may be a useful strategy in chemo-resistant disease for patients with
tumors that have high TMB, MSI-H, or dMMR, despite a low overall response rate in
unselected populations.
What challenges exist for patients receiving tumor-agnostic therapies? - Answer-
Without insurance coverage, tumor-agnostic therapies can be very expensive and
financially challenging for patients and their families.
What histopathological subtype of penile SCC is associated with poorer outcomes? -
Answer-Sarcomatoid SCC has been linked to a more aggressive disease course and a
higher propensity for early metastatic disease.
Management Exam Questions with
100% Correct Answers
What is the recommendation for the management of patients with high-risk node-
positive disease? - Answer-Adjuvant treatment should be considered as a tool in post-
operative management.
What is the recommended initial treatment for biopsy-proven PeIN located on the glans
or prepuce? - Answer-Circumcision is recommended as the initial treatment.
What alternative treatment can be used for residual PeIN besides topical agents? -
Answer-CO2 laser ablation can be used.
What is the typical external beam radiation therapy (EBRT) course for penile cancer? -
Answer-66-74 Gy in 2 Gy fractions, five times per week.
What are the recommended doses for low-dose rate (LDR) and high-dose rate (HDR)
brachytherapy in penile cancer treatment? - Answer-LDR: 60-65 Gy continuously; HDR:
35 Gy in nine fractions over 5 days.
What is the recommended treatment for low-volume residual disease in penile cancer? -
Answer-38.4 Gy in 12 fractions.
What is the most frequently proposed radiation schedule for intact tumors in penile
cancer? - Answer-42-45 Gy in 12-14 fractions.
What surgical procedure is recommended for lesions involving the glans? - Answer-
Wide local excision or glans resurfacing with reconstruction using SSG or penile shaft
skin.
When is Mohs micrographic surgery considered for penile lesions? - Answer-For low-
grade penile lesions (T1) if the right clinical setup is available.
What should be considered for patients with cN3 fixed nodes in penile cancer? -
Answer-Neoadjuvant chemotherapy with triplet regimens such as TIP or TPF.
,What is recommended for T2 tumors of the glans penis? - Answer-Glansectomy with or
without distal urethrectomy and SSG reconstruction.
What treatment options are available for patients with disease progression or
unresectable lymph nodes? - Answer-Additional systemic chemotherapy, local-field
radiation therapy, or participation in a clinical trial.
What is the recommended adjuvant treatment for patients with pN3 disease? - Answer-
Adjuvant radiation therapy with at least 50 Gy in 2 Gy fractions or a biological equivalent
dose.
What is the median overall survival (OS) for patients with metastatic penile SCC after
first-line chemotherapy failure? - Answer-Median OS is only 6-8 months.
What combination chemotherapy regimens are recommended for first-line treatment of
metastatic disease? - Answer-Cisplatin plus 5-FU, carboplatin plus paclitaxel, TIP, and
TPF.
What is the median OS associated with second-line treatment using single-agent
paclitaxel? - Answer-Median OS of 23 weeks.
What was the median OS reported for second-line treatment with epidermal growth
factor receptor-targeted therapy? - Answer-Median OS of 29.6 weeks.
What challenges do inoperable cases of recurrent penile cancer present? - Answer-
Inoperable cases present challenges for palliation and wound management.
What is the role of molecular profiling in the treatment of penile cancer? - Answer-
Molecular profiling can guide treatment decisions, especially in recurrent disease.
What is the significance of the Eastern Cooperative Oncology Group (ECOG)
performance status in treatment decisions? - Answer-ECOG performance status helps
determine the suitability of patients for specific chemotherapy regimens.
What is the recommended approach for managing recurrent disease at the primary
tumor site? - Answer-Further surgery can help palliate these patients when feasible.
What is the role of systemic therapy in the second-line setting for metastatic penile
cancer? - Answer-There are very limited data, but single-agent therapies like paclitaxel
have been used.
What are the management options for recurrent disease on the glans without corpus
cavernosum invasion? - Answer-Wide local excision, distal corporectomy, or
brachytherapy in selected cases.
,What surgical options may be required for more extensive disease involving the corpus
cavernosum? - Answer-Partial or total penectomy.
What is the role of palliative chemotherapy (ChT) in metastatic penile cancer? - Answer-
It is used to improve symptoms and prolong life.
What is the classical backbone of therapy for metastatic penile cancer? - Answer-
Platinum-based chemotherapy.
What are some commonly utilized chemotherapy regimens for metastatic penile
cancer? - Answer-Cisplatin with 5-FU and platinum with taxane.
What is the median progression-free survival (PFS) for cisplatin and 5-FU in penile
cancer treatment? - Answer-20 weeks.
What is the median overall survival (OS) reported for cisplatin and 5-FU in penile cancer
treatment? - Answer-8 months.
What response rates have been associated with chemotherapy regimens in penile
cancer? - Answer-Partial response or clinical benefit rates of 20%-40%.
What was the response rate reported in a UK study using the TPF regimen for penile
cancer? - Answer-38%.
What toxicity rate was observed in the TPF regimen study? - Answer-63% for grade 3-4
toxicity.
What was the response rate for the TIP regimen used as neoadjuvant treatment for
inoperable disease? - Answer-Approximately 50%.
What is the clinical benefit rate reported for the vinca alkaloid vinflunine in penile
cancer? - Answer-45%.
What response rate was reported in a phase II study of the HER tyrosine kinase
inhibitor dacomitinib? - Answer-33%.
What is the significance of programmed death-ligand 1 (PD-L1) in penile squamous cell
carcinoma (SCC)? - Answer-It may be amenable to therapeutic intervention with PD-L1-
targeted immunotherapies.
What is the FDA-approved anti-PD-L1 agent for patients with cutaneous, inoperable
SCC? - Answer-Cemiplimab.
What response rate was reported from the phase II trial of cemiplimab? - Answer-47%.
, What was the median overall survival (OS) in the PERICLES trial for advanced penile
SCC? - Answer-11.3 months.
What was the response rate in the PERICLES trial for atezolizumab treatment arms? -
Answer-16.7%.
What is the overall disease control rate reported in the GSRGT retrospective study for
metastatic penile cancer? - Answer-35%.
What should be considered for patients with no response or disease progression after
initial treatment? - Answer-Second-line systemic chemotherapy or radiotherapy for local
control, best supportive care, or a clinical trial.
What is recommended for local control in the presence of metastatic inoperable
disease? - Answer-Palliative radiotherapy or radiotherapy with concurrent
chemotherapy.
What factors may allow for the use of anti-PD-L1 immunotherapy in selected patients? -
Answer-High tumor mutational burden (TMB), microsatellite instability-high (MSI-H), or
mismatch repair deficiency (dMMR).
What is the importance of biomarker-selected clinical trials in penile cancer treatment? -
Answer-They should be considered where available.
What is the significance of high TMB and MSI-H in cancer treatment? - Answer-High
Tumor Mutational Burden (TMB) and microsatellite instability-high (MSI-H) status are
associated with positive responses to immunotherapy, such as pembrolizumab, in
patients with unresectable or metastatic solid tumors.
What is the FDA approval status of pembrolizumab? - Answer-Pembrolizumab has FDA
approval for use in a tumor-agnostic setting based on responses seen in patients with
unresectable or metastatic MSI-H or mismatch repair deficient (dMMR) solid tumors.
What are the potential benefits of immunotherapy in penile cancer? - Answer-
Immunotherapy may be a useful strategy in chemo-resistant disease for patients with
tumors that have high TMB, MSI-H, or dMMR, despite a low overall response rate in
unselected populations.
What challenges exist for patients receiving tumor-agnostic therapies? - Answer-
Without insurance coverage, tumor-agnostic therapies can be very expensive and
financially challenging for patients and their families.
What histopathological subtype of penile SCC is associated with poorer outcomes? -
Answer-Sarcomatoid SCC has been linked to a more aggressive disease course and a
higher propensity for early metastatic disease.
