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International penile advanced cancer trial  - an International Rare Cancers Initiative study

Disease site: Penile cancer, urological cancers

Treatment modalities: Combinations of surgery, neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and adjuvant chemoradiotherapy.

Status: Open to recruitment

Trial details

InPACT is an international phase III trial with a Bayesian design incorporating two sequential randomisations (InPACT-neoadjuvant and InPACT-pelvis) in patients with squamous carcinoma of the penis who have inguinal lymph node metastases (i.e. locally advanced disease). InPACT aims to determine:

  • If there is a role for neoadjuvant therapy in this patient group; and
  • If prophylactic pelvic lymph node dissection (PLND) improves survival in patients at high risk of recurrence following inguinal lymph node dissection (ILND).

200 patients will be recruited (49 from UK sites; 151 US & European sites) over a 7 year period.

In randomisation 1 (InPACT-neoadjuvant), dependent on disease burden strata, patients are allocated to one of three initial treatment arms:

  • Standard surgery (ILND) – no neoadjuvant treatment;
  • Neoadjuvant chemotherapy followed by ILND; or
  • Neoadjuvant chemoradiotherapy followed by ILND.

In randomisation 2 (InPACT-pelvis), patients at high risk of relapse (based on histological interpretation of the ILND specimen) are randomised to either:

  • Prophylactic PLND; or
  • No prophylactic PLND (surveillance).

Patients in both arms will also receive adjuvant chemoradiotherapy, if not already received in the neoadjuvant setting.

Further information

Chief Investigators:

  • Dr Steve Nicholson (Study Chair), c/o ICR-CTSU
  • Dr Curtis Pettaway (US Co-Chair), MD Anderson Cancer Centre, Houston, TX, USA
  • Mr Nick Watkin (National Coordinator for the UK), St George’s Healthcare NHS Trust

ICR-CTSU Scientific Lead: Prof Emma Hall

Trial management contact: [email protected]


UK Sponsor: The Institute of Cancer Research


Funding: Cancer Research UK (CRUK/13/005)

View InPACT on the National Institute for Health Research website: NIHR - Be Part Of Research

Read a plain English summary of InPACT from Cancer Research UK.

Publications and presentations

Daniel J. Canter, Steve Nicholson, Nick Watkin, Emma Hall, Curtis Pettaway, on behalf on the InPACT Exectutive Committee. The International Penile Advanced Cancer Trial (InPACT): Rationale and Current Status. European Urology Focus, Volume 5, Issue 5, 2019, Pages 706-709, ISSN 2405-4569,

This research was funded by the Stand Up to Cancer campaign for Cancer Research UK


Clinical trials

Division of Clinical Studies

The division carries out or coordinates high-quality trials and translational research at both an early phase – typically to test new targeted drugs – and a later stage.