A Regimen of Taxol, Ifosfamide, and Platinum for Recurrent Advanced Squamous Cell Cancer of the Anal Canal

Abstract

The typically recommended chemotherapy options in metastatic anal cancer generally yield partial remissions with limited benefit for the majority of patients. TIP is a regimen containing paclitaxel (Taxol), ifosfamide, and cisplatin that is known to have significant activity in patients with squamous cell cancers of the head and neck as well as in cervical cancer, both of which are malignancies strongly associated with oncogenic strains of human papilloma virus (HPV). Interestingly, squamous cell cancer of the anal canal shares an almost identical pathophysiology including causal association with HPV. Due to this, we chose to use the TIP regimen to treat patients with advanced anal cancer at our institution and report our findings on three such consecutive patients. All the patients tolerated the regimen well with manageable side effects and had excellent responses with complete resolution of PET activity after treatment. Our observations suggest that TIP is highly active for squamous cell cancer of the anal canal and warrants further study in the treatment of this disease.

Platinum-Fluoropyrimidine and Paclitaxel-Based Chemotherapy in the Treatment of Advanced Anal Cancer Patients

“…Additional therapeutic approaches, including triplet chemotherapy and anti‐EGFR monoclonal antibodies, have been reported as potentially effective in this setting . In our study, such treatments were used in only 4 and 2 patients, respectively, thereby largely precluding any meaningful analysis or comparison with other series.…”

“…So far, the decision-making process for advanced anal cancer patients has been based on evidence of suboptimal quality, largely consisting of anecdotal case reports; case series; phase I studies; or small, single-arm phase II studies [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. The relatively low incidence of this condition, the common pattern of clinical presentation at diagnosis, and the high success rate of definitive chemoradiotherapy for early-stage tumors have historically hampered the development of randomized clinical trials.…”

“…As with other rare cancers, randomized clinical trials are lacking, and the only available evidence to inform the management of this condition comes from a limited number of small, single-center, retrospective studies that used single-agent or combination chemotherapy regimens in heterogeneous patient populations [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. This uncertainty is reflected by the lack of strong recommendations from most international guidelines [34,35].…”

Management of Two Cases of Recurrent Anal Carcinoma

“…One such combination regimen for recurrent squamous cell anal cancer described recently by Golub et al [16] included paclitaxel, ifosfamide and cisplatin (TIP regimen). Responses in this setting have also been observed with single-agent carboplatin [17], irinotecan [18], and cetuximab [10], or the combination of irinotecan and cetuximab [8].…”

Recurrent metastatic anal cancer treated with modified paclitaxel, ifosfamide, and cisplatin and third-line mitomycin/cetuximab

“…TIP is a regimen well known in the treatment of SCC in head and neck cancers and cervical cancers. Golub et al 12 described the first report of the use of TIP chemotherapy in anal cancer in three cases where complete remission was achieved after three or four cycles and durable response ranged 4-28 months.…”