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ESMO 2026 | Hurdles in treating squamous cell carcinoma of the genitourinary tract

Andrea Necchi, MD, IRCCS San Raffaele Hospital and Scientific Institute, Milan, Italy, highlights the challenges of treating squamous cell carcinoma in genitourinary (GU) oncology, particularly for rare tumors such as penile, urethral, and bladder cancer. There is unfortunately a lack of guidelines for these rare tumors, where the standard treatment often involves radical surgery, but emerging data suggest a potential role for immunotherapy, including immune checkpoint inhibitors, in selected patients. This interview took place at the European Society for Medical Oncology (ESMO) 2026 Congress in Madrid, Spain.

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Transcript

Squamous cell carcinoma represents a very difficult field in general for GU oncology because they represent rare tumors in general with all the limitations in doing research and developing guidelines in rare tumors. So I focused my attention in the educational session on penile cancer and squamous cell tumors for urethra and bladder. In these last two cases, we are dealing with very few cases, very rare tumors, accounting for a total 1 to 2% of the total diagnosis, for example, of bladder cancer...

Squamous cell carcinoma represents a very difficult field in general for GU oncology because they represent rare tumors in general with all the limitations in doing research and developing guidelines in rare tumors. So I focused my attention in the educational session on penile cancer and squamous cell tumors for urethra and bladder. In these last two cases, we are dealing with very few cases, very rare tumors, accounting for a total 1 to 2% of the total diagnosis, for example, of bladder cancer. We don’t have any guidelines. The standard approach for organ-confined tumor is to perform radical surgery. There are initial data from clinical trials putting the eye on the immune checkpoint inhibitor combination or immune checkpoint inhibitors because of the fact that from the biomarker standpoint, squamous cell tumors still are endowed with enrichment in biomarkers that are putative biomarkers for immunotherapy activity. For penile cancer we do have pretty well established guidelines that still put lymphadenectomy and surgery at the center or the forefront of the treatment of these patients and we are here in this space developing projects and developing trials and developing evidence suggesting that immunotherapy could have a role in selected patients, maybe in association with chemotherapy, in curing more patients or allowing more patients with unresectable disease to become resectable and to potentially be cured for locally advanced disease.

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