Chemotherapy for Penile Cancer

Chemotherapy (chemo) is the use of drugs to treat cancer. Two types of chemotherapy can be used in treating penile cancer:

• Topical
• Systemic

Topical chemotherapy is described in Local Treatments (Other than Surgery) for Penile Cancer.

Systemic chemotherapy

Systemic chemo uses cancer-killing drugs that are injected into a vein or given by mouth. These drugs go through the bloodstream and reach cancer cells throughout the body. This treatment is most often used for penile cancers that have spread to lymph nodes or distant organs. Chemo might also be used to shrink tumors before surgery to make them easier to remove. It's being studied to see if giving it after surgery (called adjuvant chemotherapy) will help keep the cancer from coming back and improve survival.

Doctors give chemo in cycles, with each cycle of treatment followed by a rest period to give the body time to recover. Chemo cycles generally last about 3 to 4 weeks. Some of the drugs used to treat penile cancer include:

• Cisplatin
• Fluorouracil (5-FU)
• Paclitaxel (Taxol^®)
• Ifosfamide (Ifex^®)
• Mitomycin C
• Capecitabine (Xeloda^®)

Often, 2 or more of these drugs are used together to treat penile cancer that has spread to lymph nodes or other organs. Some common combinations include:

• Cisplatin plus 5-FU
• TIP: paclitaxel (Taxol), ifosfamide, and cisplatin ("platinum")

Possible side effects of chemotherapy

Chemo drugs attack cells that are dividing quickly, which is why they work against cancer cells. But other cells in the body, such as those in the bone marrow (where new blood cells are made), the lining of the mouth and intestines, and the hair follicles, divide quickly, too. These cells can also be affected by chemo, which can lead to some side effects.

The side effects of chemo depend on the type and dose of the drugs and how long they are used. Common side effects can include:

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea or constipation
• Increased chance of infections (from low white blood cell counts)
• Easy bruising or bleeding (from low blood platelet counts)
• Fatigue (from low red blood cell counts)

These side effects usually go away over time after treatment ends. There are often ways to lessen chemo side effects. For instance, you can get medicine to help prevent or reduce nausea and vomiting.

Some of the drugs used to treat penile cancer can have other side effects.

• Cisplatin and paclitaxel can cause nerve damage (neuropathy), which can lead to numbness and tingling in the hands and feet.
• Cisplatin can also cause and kidney damage (nephropathy). Doctors give a lot of intravenous (IV) fluid with cisplatin to help prevent this.
• 5-fluorouracil (5-FU) and capecitabine can cause sores in the mouth (mucositis) that can make it hard to eat. These drugs can also cause diarrhea.
• Ifosfamide can damage the lining of the bladder (hemorrhagic cystitis). A drug called mesna is often given with ifosfamide to help keep this from happening.

Be sure to ask your doctor or nurse about ways to help reduce side effects, and let them know when you do have side effects so they can be managed.