HPV status affects survival in penile intraepithelial neoplasia patients

In patients with penile intraepithelial neoplasia (PeIN), testing positive for p16 overexpression, as a surrogate marker for high-risk human papillomavirus (HPV), correlates with longer disease-free survival (DFS), a recent study has found. Moreover, combination treatment with immunotherapy seems to boost response regardless of p16 status.

Accessing electronic medical records, the researchers enrolled 137 PeIN patients (median age 63 years) who had no invasive cancers, diagnosed between 2008 and 2018. Aside from basic demographic factors, retrieved data included smoking status, HPV/p16 status, comorbidities, and treatment and clinical response.

P16 staining data were available for 91 patients, of whom 74 were found to be positive. DFS was significantly longer in P16+ patients than in comparators without high-risk HPV (10.4 vs 7.4 months; p=0.023). Moreover, treatment regimens with imiquimod (alone or with surgery) achieved a 100-percent response rate in p16+, while those without imiquimod had a response rate of only 54 percent (p=0.017).

A similar pattern of effect was observed in p16– patients, where regimens with vs without imiquimod achieved higher rates of treatment response, though the difference failed to reach significance (100 percent vs 56 percent; p=0.99). Progression to squamous cell carcinoma was detected in 13.6 percent of participants despite intervention, with the rate not differing between p16+ and p16– patients.

Smoking status, comorbidities, lichen sclerosis, and Eastern Cooperative Oncology Group performance status did not affect DFS.

“Importantly, this study has also established that around 14 percent of patients may progress to invasive disease despite treatment. This may have implications for focusing on preventative approaches against PeIN and subsequent penile cancer,” the researchers said.

“However, given the limitations of this work further study is required to confirm these findings,” they added.