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

Sclafani, Francesco; Morano, Federica; Cunningham, David; Baratelli, Chiara; Kalaitzaki, Eleftheria; Watkins, David; Starling, Naureen; Chau, Ian; S, Rao

doi:10.1634/theoncologist.2016-0241

Cited by 35 publications

(34 citation statements)

References 36 publications

(62 reference statements)

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“…More recently, a retrospective analysis of 64 patients with inoperable locally advanced SCCA showed that second‐line systemic treatment was administrated to approximately one‐third of patients after failure of a combination of platinum agent plus 5‐FU. Progression‐free survival after second‐line chemotherapy was also 3.2 months (IQR, 2.5‐7.1 months) in this case …”

Section: Discussionsupporting

confidence: 50%

Mitomycin and 5‐fluorouracil for second‐line treatment of metastatic squamous cell carcinomas of the anal canal

et al. 2019

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BackgroundMetastatic squamous cell carcinomas (SCC) of the anal canal are rare and there is no international consensus on their second‐line management. 5‐Fluorouracil (5‐FU) and mitomycin in combination with radiotherapy is the standard for locally advanced forms but its efficacy in metastatic stage has never been evaluated.Patients and methodsWe report a retrospective analysis of patients treated with 5‐FU and mitomycin from 2000 to 2017 in our institution for a metastatic SCC of the anal canal after failure of platinum‐based regimen. The main outcome was progression‐free survival (PFS) and the secondary outcomes were overall survival (OS), response rate, and toxicity.ResultsNineteen patients, 15 women and four men, with a median age of 57 years were identified (range, 40‐79 years). Patients received a median of three cycles (1‐7) of mitomycin 5‐FU. A dose reduction was necessary in six patients (31.6%), one patient had to discontinue treatment following toxicity and no death was due to treatment toxicity was reported. An objective response was observed in five patients (26.4%, 95% CI 6.6‐46.2) including one complete response, six patients (31.6%, 95% CI 10.7‐52.5) showed tumor stabilization. Median PFS and OS were 3 months [95% CI 1‐5] and 7 months [95% CI 2.2‐11.8]. Responder had a median duration of response of 4 months [95% CI 1.8‐6.1] and one patient had 23 months duration of response. No significant difference was noted for PFS and OS for patients previously treated with mitomycin and 5‐FU at a local stage.ConclusionMitomycin and 5‐FU regimen provides tumor control with acceptable tolerance. It is an option for patients with metastatic SCC of the anal canal after failure of platinum‐based chemotherapy. [Correction added on 9 October 2019, after first online publication: '5‐FU' was inadvertently removed from the Results and Conclusion and has now been added to the text.]

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Section: Discussionsupporting

confidence: 50%

Mitomycin and 5‐fluorouracil for second‐line treatment of metastatic squamous cell carcinomas of the anal canal

et al. 2019

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“…At 2 years, 40% and 20% of patients in the respective groups were still alive. The increased consideration which has been given to the use of organ‐directed therapies is further confirmed by the proportion of treatment‐eligible patients who were managed with a multidisciplinary treatment approach in the two largest published retrospective series of advanced anal SCC from the Royal Marsden Hospital and the MD Anderson Cancer Center (37% and 43%, respectively) . Of note, in a further publication from the group at the MD Anderson Cancer Center the 5‐year OS of 28 patients who had undergone liver metastasectomy for SCCs (including 19 patients with anal SCC) was 47% and therefore comparable overall to the survival outcomes previously reported for colorectal cancer .…”

Section: Discussionmentioning

confidence: 90%

“…It should be noted that, while these data suggest that the magnitude of benefit deriving from organ‐directed treatments is smaller for anal SCC patients than for patients with other tumor types, they do not rule out that a multidisciplinary treatment approach may still play a role in the management of this disease. This is especially true if we consider that, despite the encouraging results of recent trials in the chemonaive and chemorefractory setting, the treatment options for advanced anal SCC patients are limited, robust management guidelines are lacking and the median overall survival is still less than 2 years . It is not surprising then that multimodality treatment strategies are increasingly adopted in routine clinical practice and reported in retrospective series (Table ).…”

Section: Discussionmentioning

confidence: 99%

“…In the first line setting, combination chemotherapy regimens including a platinum, fluoropyrimidine and/or taxane have shown activity and are generally recommended by international guidelines . Nevertheless, the prognosis of these patients remains poor with a median overall survival of 14 to 22 months . It is clear that more effective treatment strategies are urgently needed.…”

Section: Introductionmentioning

confidence: 99%

“…The rarity of advanced anal SCC represents an obvious obstacle to assessing the role of a similarly aggressive treatment approach in this disease setting. Nevertheless, multimodality therapies have been increasingly used in these patients as reported in recent retrospective studies, suggesting that there are growing expectations from physicians that combining systemic chemotherapy with organ‐directed treatments may provide an incremental survival advantage over systemic chemotherapy alone, at least in carefully selected patients with oligometastatic disease …”

Section: Introductionmentioning

confidence: 99%

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Multimodality treatment of oligometastatic anal squamous cell carcinoma: A case series and literature review

Sclafani

Hesselberg

Thompson

et al. 2019

Journal of Surgical Oncology

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Background and Objectives There is limited evidence to guide the management of patients with oligometastatic anal squamous cell carcinoma (SCC). We aimed to address this question by reporting the outcome of SCC patients who were treated with organ‐directed therapies at two large cancer centers. Methods Patients with advanced anal SCC who were treated with surgery, stereotactic radiotherapy, or radiofrequency ablation (RFA) with a curative intent from 2008 to 2017 were retrospectively identified from the institutional electronic patient records. Results Eight patients with liver or lung metastases met the study inclusion criteria. Seven were treated with surgery while one received RFA and radiotherapy. Median progression‐free survival was 5 months (range, 4‐39). Three patients underwent repeat organ‐directed treatment upon failure of the initial surgery with no evidence of further recurrent disease at the last follow‐up. Median overall survival from the time of the first organ‐directed therapy was 31 months (range, 11‐96) with two out of eight patients being alive and disease‐free at 5 years. Conclusions Our study confirms that consideration should be given to the adoption of a multidisciplinary treatment approach in carefully selected, oligometastatic anal SCC patients as organ‐directed therapies may offer the chance of achieving a relatively long disease control.

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Neoplasms of the Anus

Jácome

Eng

2022

Holland‐Frei Cancer Medicine

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Overview Squamous cell carcinoma of the anal canal (SCCA) is a rare human papillomavirus (HPV)‐related malignancy, but with rising incidence in the last decade. Chemoradiotherapy (CRT) remains the cornerstone of the treatment of non‐metastatic disease, characterized by remarkable response rates of 90% and 5‐year overall survival (OS) of 80%. Nevertheless, despite the high efficacy observed with combined modality treatment, almost half of the patients with locally advanced disease have high‐risk features (T3, T4, or node‐positive disease) for treatment failure. The management of unresectable recurrences or metastatic disease is an unmet clinical need, marked by poor clinical outcomes. Immune checkpoint inhibitors and immunotherapeutic approaches have been demonstrating promising results in the management of advanced disease in the past few years, but big steps forward will only be taken when the underutilized HPV vaccination becomes more widely accepted for use.

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

Cited by 35 publications

References 36 publications

Mitomycin and 5‐fluorouracil for second‐line treatment of metastatic squamous cell carcinomas of the anal canal

Mitomycin and 5‐fluorouracil for second‐line treatment of metastatic squamous cell carcinomas of the anal canal

Multimodality treatment of oligometastatic anal squamous cell carcinoma: A case series and literature review

Neoplasms of the Anus

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