Dr. Garje on survival outcomes in penile cancer based on HPV status

In this video, Rohan Garje, MD, highlights the background, key findings, and implications based on the study, “Implications of HPV infection on survival outcomes in patients with penile squamous cell carcinoma: Insights from a nationwide study,” which was presented at the 2024 American Society of Clinical Oncology Annual Meeting in Chicago, Illinois. Garje is the chief of genitourinary medical oncology at Miami Cancer Institute/Baptist Health Medical Group in Florida.

Video Transcript:

Could you describe the background and key findings from this study?

HPV infection, as we know, is associated with penile cancer. What we wanted to look at in this large database is to see if it has an impact on patients' survival, irrespective of the stage. Penile cancer can present in various stages. We identified about almost 1400 men with penile cancer in the study. Among them, about 40% had HPV-positive disease, whereas about almost 60%, did not have an HPV infection. This is irrespective of the stage. So, we included all patients in this study, from stage 1 to stage 4. Then, we subdivided these patients into 2 groups: who had HPV-positive disease and HPV-negative disease. What we found was irrespective of what treatment they had, either surgery alone or chemotherapy or combinations or radiation therapy, the primary benefit of HPV was seen in the sense that patients who had HPV-positive disease had better outcomes. This is an important finding, which we will use in earlier risk prognostication for patients where treatment can be tailored, potentially based on HPV status.

Is there anything else you wanted to add regarding the findings?

When we look at the overall cohort, irrespective of stage, when patients with HIV-positive penile cancer was seen, the median overall survival was almost 123 months, compared to patients who had HPV-negative, who had inferior survival of 104 months. Now, this includes all stages, not a particular stage. So, it includes as early as stage 1 to stage 4. This survival benefit with HPV-positive disease was irrespective of patient's age, comorbidities, stage of the disease, and also treatment modality use for the patients.

What are the implications of these findings?

One of the important implications would be in day-to-day clinical practice, I think HPV testing is a primary requirement. It would be good to have a pathologists report this as a part of their testing, because this can help treating physicians, urologists to utilize this data to prognosticate their patients. Right now, we know that it has better prognosis. The other important aspect now is, will it help in tailoring treatment? That is the biggest question now, because in other cancers, we do see in head and neck treatment modifications can be done using HPV status. But currently in penile cancer, we don't have that yet. So, irrespective of HPV status, the treatment paradigm is the same. There could be a paradigm where we can utilize this to tailor the treatment choices. Obviously, this has to be studied in a prospective study or maybe an observational study. There are challenges we can see; it's a rare group, and it requires a huge collaborative effort in order to tease out a prospective study. So, there are some limitations. I think my immediate hope and goal with the study finding is universal incorporation of HPV testing on all penile cancer patients.

This transcription has been edited for clarity.