Abstract
Squamous cell carcinoma of the anus (SCCA) is a rare disease in the average population but is an increasing concern among immunocompromised individuals, such as the HIV-seropositive. Coinfection with human papillomavirus (HPV) in this population is common. HPV infection is difficult to clear with a compromised immune system, which results in a greater risk of tumor development and a more aggressive progression of the disease. The recent approval of a prophylactic HPV vaccine for cervical cancer has sparked an interest in a search for improved immunotherapeutic multimodality therapies to combat anogenital tumors associated with the virus. In this review, we discuss the known mechanisms of action of HIV-associated SCCA, examine the current treatments for the disease, and focus on the potential of an immunotherapeutic vaccine approach for both prophylactic and therapeutic application.
Similar content being viewed by others
References
Fagan SP, Bellows CF III, Albo D et al (2005) Length of human immunodeficiency virus disease and not immune status is a risk factor for development of anal carcinoma. Am J Surg 190:732–735
Ryan DP, Compton CC, Mayer RJ (2000) Carcinoma of the anal canal. N Engl J Med 342:792–800
Wexler A, Berson AM, Goldstone SE et al (2008) Invasive anal squamous-cell carcinoma in the HIV-positive patient: outcome in the era of highly active antiretroviral therapy. Dis Colon Rectum 51:73–81
Konstantinopoulos PA, Schlecht HP, Bryan B et al (2006) HIV-associated anal squamous cell cancer: an otherwise preventable disease. J Clin Oncol 24:4516–4517
Zhang J, Martins CR, Fansler ZB et al (2005) DNA methylation in anal intraepithelial lesions and anal squamous cell carcinoma. Clin Cancer Res 11:6544–6549
Oehler-Janne C, Huguet F, Provencher S et al (2008) HIV-specific differences in outcome of squamous cell carcinoma of the anal canal: a multicentric cohort study of HIV-positive patients receiving highly active antiretroviral therapy. J Clin Oncol 26:2550–2557
Tachezy R, Jirasek T, Salakova M et al (2007) Human papillomavirus infection and tumours of the anal canal: correlation of histology, PCR detection in paraffin sections and serology. Apmis 115:195–203
Esiashvili N, Landry J, Matthews RH (2002) Carcinoma of the anus: strategies in management. Oncologist 7:188–199
Palefsky JM, Holly EA, Gonzales J et al (1991) Detection of human papillomavirus DNA in anal intraepithelial neoplasia and anal cancer. Cancer Res 51:1014–1019
Sirera G, Videla S, Herranz P, Corzo-Delgado JE (2006) Human papillomavirus and HIV/AIDS. Enferm Infecc Microbiol Clin 24:40–46
Uronis HE, Bendell JC (2007) Anal cancer: an overview. Oncologist 12:524–534
Palefsky JM, Holly EA, Ralston ML et al (1998) High incidence of anal high-grade squamous intra-epithelial lesions among HIV-positive and HIV-negative homosexual and bisexual men. AIDS 12:495–503
Schlecht NF, Burk RD, Palefsky JM et al (2005) Variants of human papillomaviruses 16 and 18 and their natural history in human immunodeficiency virus-positive women. J Gen Virol 86:2709–2720
Nahas CS, Lin O, Weiser MR et al (2006) Prevalence of perianal intraepithelial neoplasia in HIV-infected patients referred for high-resolution anoscopy. Dis Colon Rectum 49:1581–1586
Nadal SR, Horta SH, Calore EE, Manzione CR (2007) Outcome of treatment of anal squamous cell carcinoma and its precursor in HIV-infected patients. Rev Assoc Med Bras 53:365–369
Frisch M, Fenger C, van den Brule AJ et al (1999) Variants of squamous cell carcinoma of the anal canal and perianal skin and their relation to human papillomaviruses. Cancer Res 59:753–757
Degener AM, Laino L, Pierangeli A et al (2004) Human papillomavirus-32-positive extragenital Bowenoid papulosis (BP) in a HIV patient with typical genital BP localization. Sex Transm Dis 31:619–622
Ljubojevic S (2006) The human papillomavirus vaccines. Acta Dermatovenerol Croat 14:208
Bernard HU, Calleja-Macias IE, Dunn ST (2006) Genome variation of human papillomavirus types: phylogenetic and medical implications. Int J Cancer 118:1071–1076
Nahas SC, Nahas CS, a Filho EV et al (2007) Perianal squamous cell carcinoma with high-grade anal intraepithelial neoplasia in an HIV-positive patient using highly active antiretroviral therapy: case report. Sao Paulo Med J 125:292–294
Melbye M, Cote TR, Kessler L et al (1994) High incidence of anal cancer among AIDS patients. The AIDS/Cancer Working Group. Lancet 343:636–639
Frisch M, Glimelius B, van den Brule AI et al (1998) Sexually transmitted infection as a cause of anal cancer. Ugeskr Laeger 160:7109–7117
Da Costa MM, Hogeboom CJ, Holly EA, Palefsky JM (2002) Increased risk of high-grade anal neoplasia associated with a human papillomavirus type 16 E6 sequence variant. J Infect Dis 185:1229–1237
Giuliani L, Ronci C, Bonifacio D et al (2008) Detection of oncogenic DNA viruses in colorectal cancer. Anticancer Res 28:1405–1410
Goldstone SE, Kawalek AZ, Huyett JW (2005) Infrared coagulator: a useful tool for treating anal squamous intraepithelial lesions. Dis Colon Rectum 48:1042–1054
Gervaz P, Hahnloser D, Wolff BG et al (2004) Molecular biology of squamous cell carcinoma of the anus: a comparison of HIV-positive and HIV-negative patients. J Gastrointest Surg 8:1024–1030
von Knebel Doeberitz M, Rittmuller C, Aengeneyndt F et al (1994) Reversible repression of papillomavirus oncogene expression in cervical carcinoma cells: consequences for the phenotype and E6-p53 and E7-pRB interactions. J Virol 68:2811–2821
Hiller T, Poppelreuther S, Stubenrauch F, Iftner T (2006) Comparative analysis of 19 genital human papillomavirus types with regard to p53 degradation, immortalization, phylogeny, and epidemiologic risk classification. Cancer Epidemiol Biomarkers Prev 15:1262–1267
Hiller T, Stubenrauch F, Iftner T (2008) Isolation and functional analysis of five HPVE6 variants with respect to p53 degradation. J Med Virol 80:478–483
Duensing A, Chin A, Wang L et al (2008) Analysis of centrosome overduplication in correlation to cell division errors in high-risk human papillomavirus (HPV)-associated anal neoplasms. Virology 372:157–164
Hu G, Liu W, Hanania EG et al (1995) Suppression of tumorigenesis by transcription units expressing the antisense E6 and E7 messenger RNA (mRNA) for the transforming proteins of the human papilloma virus and the sense mRNA for the retinoblastoma gene in cervical carcinoma cells. Cancer Gene Ther 2:19–32
Palefsky JM, Gillison ML, Strickler HD (2006) Chapter 16: HPV vaccines in immunocompromised women and men. Vaccine 24:S140–146
Grandhi JPAWPT, Shields AF, Vaishampayan U et al (2006) A retrospective review of anal squamous cell carcinoma in HIV positive and HIV negative patients. J Clin Oncol 24:4153
Nathan M, Hickey N, Mayuranathan L et al (2008) Treatment of anal human papillomavirus-associated disease: a long term outcome study. Int J STD AIDS 19:445–449
Pineda CE, Berry JM, Jay N et al (2007) High resolution anoscopy in the planned staged treatment of anal squamous intraepithelial lesions in HIV-negative patients. J Gastrointest Surg 11:1410–1415
Herat A, Shirato K, Damian DL et al (2006) Invasive squamous cell carcinoma arising in refractory perianal Bowen’s disease in a HIV-positive individual. Australas J Dermatol 47:120–123
Abramowitz L, Benabderrahmane D, Ravaud P et al (2007) Anal squamous intraepithelial lesions and condyloma in HIV-infected heterosexual men, homosexual men and women: prevalence and associated factors. AIDS 21:1457–1465
Vatra B, Sobhani I, Aparicio T et al (2002) Anal canal squamous-cell carcinomas in HIV positive patients: clinical features, treatments and prognosis. Gastroenterol Clin Biol 26:150–156
Sobhani I, Walker F, Aparicio T et al (2002) Effect of anal epidermoid cancer-related viruses on the dendritic (Langerhans’) cells of the human anal mucosa. Clin Cancer Res 8:2862–2869
Petter A, Heim K, Guger M et al (2000) Specific serum IgG, IgM and IgA antibodies to human papillomavirus types 6, 11, 16, 18 and 31 virus-like particles in human immunodeficiency virus-seropositive women. J Gen Virol 81:701–708
Gervaz P, Hirschel B, Morel P (2006) Molecular biology of squamous cell carcinoma of the anus. Br J Surg 93:531–538
Kreuter A, Brockmeyer NH, Hochdorfer B et al (2005) Clinical spectrum and virologic characteristics of anal intraepithelial neoplasia in HIV infection. J Am Acad Dermatol 52:603–608
Sobhani I, Walker F, Roudot-Thoraval F et al (2004) Anal carcinoma: incidence and effect of cumulative infections. AIDS 18:1561–1569
Gervaz E, Dauge-Geffroy MD, Sobhani I et al (1995) Quantitative analysis of the immune cells in the anal mucosa. Pathol Res Pract 191:1067–1071
Wilkins K, Turner R, Dolev JC et al (2006) Cutaneous malignancy and human immunodeficiency virus disease. J Am Acad Dermatol 54:189–206
Diamond C, Taylor TH, Aboumrad T et al (2005) Increased incidence of squamous cell anal cancer among men with AIDS in the era of highly active antiretroviral therapy. Sex Transm Dis 32:314–320
Adler W, Lee FC, Wong G (2004) Capecitabine, mitomycin C and radiation for HIV patients with anal squamous cell carcinoma. J Clin Oncol 22:4239
Chin-Hong PV, Palefsky JM (2005) Human papillomavirus anogenital disease in HIV-infected individuals. Dermatol Ther 18:67–76
Longo WE, Vernava AM III, Wade TP et al (1994) Recurrent squamous cell carcinoma of the anal canal. Predictors of initial treatment failure and results of salvage therapy. Ann Surg 220:40–49
Nigro ND, Vaitkevicius VK, Considine B Jr (1974) Combined therapy for cancer of the anal canal: a preliminary report. Dis Colon Rectum 17:354–356
Stewart D, Yan Y, Kodner IJ et al (2007) B Salvage surgery after failed chemoradiation for anal canal cancer: should the paradigm be changed for high-risk tumors? J Gastrointest Surg 11:1744–1751
Salama JK, Mell LK, Schomas DA et al (2007) Concurrent chemotherapy and intensity-modulated radiation therapy for anal canal cancer patients: a multicenter experience. J Clin Oncol 25:4581–4586
You YT, Wang JY, Changchien CR et al (1993) An alternative treatment of anal squamous cell carcinoma: combined radiotherapy and chemotherapy. J Surg Oncol 52:42–45
Wadleigh R, Dinh K, Manning J et al (2006) Low dose mitomycin c, capecitabine and radiation for HIV patients with anal squamous cell carcinoma. J Clin Oncol 24:14148
Hanna-Morris ASS, Fisher M, Cottrill C et al (2003) Chemo-Irradiation for anal squamous cell carcinoma in the era of HAART. Antivir Ther 8:944
Chadha M, Rosenblatt EA, Malamud S et al (1994) Squamous-cell carcinoma of the anus in HIV-positive patients. Dis Colon Rectum 37:861–865
Flam M, John M, Pajak TF et al (1996) Role of mitomycin in combination with fluorouracil and radiotherapy, and of salvage chemoradiation in the definitive nonsurgical treatment of epidermoid carcinoma of the anal canal: results of a phase III randomized intergroup study. J Clin Oncol 14:2527–2539
Roohipour R, Patil S, Goodman KA et al (2008) Squamous-cell carcinoma of the anal canal: predictors of treatment outcome. Dis Colon Rectum 51:147–153
Ahn J, Cho B, Choi H et al (2006) Chemoradiation and maintenance chemotherapy with cisplatin and 5-fluorouracil in anal squamous cell carcinoma. J Clin Oncol 24:14057
Cho BC, Ahn JB, Seong J et al (2008) Chemoradiotherapy with or without consolidation chemotherapy using cisplatin and 5-fluorouracil in anal squamous cell carcinoma: long-term results in 31 patients. BMC Cancer 8:8
Peiffert D, Giovannini M, Ducreux M et al (2001) High-dose radiation therapy and neoadjuvant plus concomitant chemotherapy with 5-fluorouracil and cisplatin in patients with locally advanced squamous-cell anal canal cancer: final results of a phase II study. Ann Oncol 12:397–404
de Bree E, van Ruth S, Dewit LG, Zoetmulder FA (2007) High risk of colostomy with primary radiotherapy for anal cancer. Ann Surg Oncol 14:100–108
Schiller DE, Cummings BJ, Rai S et al (2007) Outcomes of salvage surgery for squamous cell carcinoma of the anal canal. Ann Surg Oncol 14:2780–2789
Spano JP, Costagliola D, Katlama C et al (2008) AIDS-related malignancies: state of the art therapeutic challenges. J Clin Oncol 26:1–9
Chiao EY, Giordano TP, Richardson P, El-Serag HB (2008) Human immunodeficiency virus-associated squamous cell cancer of the anus: epidemiology and outcomes in the highly active antiretroviral therapy era. J Clin Oncol 26:474–479
Mathieu N, Aparicio T, Roudot-Thoraval F et al (2007) Incidence of SCCA is increasing promoted by HIV infection. J Clin Oncol 25:4632
Panther LA, Schlecht HP, Dezube BJ (2005) Spectrum of human papillomavirus-related dysplasia and carcinoma of the anus in HIV-infected patients. AIDS Read 15:79–82
Pineda CE, Berry JM, Jay N et al (2008) High-resolution anoscopy targeted surgical destruction of anal high-grade squamous intraepithelial lesions: a ten-year experience. Dis Colon Rectum 51:829–835
Mathews WC, Sitapati A, Caperna JC et al (2004) Measurement characteristics of anal cytology, histopathology, and high-resolution anoscopic visual impression in an anal dysplasia screening program. J Acquir Immune Defic Syndr 37:1610–1615
Goldstone SE, Kawalek AZ, Goldstone RN, Goldstone AB (2008) Hybrid capture II detection of oncogenic human papillomavirus: a useful tool when evaluating men who have sex with men with atypical squamous cells of undetermined significance on anal cytology. Dis Colon Rectum 51:1130–1136
Scott H, Khoury J, Moore BA, Weissman S (2008) Routine anal cytology screening for anal squamous intraepithelial lesions in an urban HIV clinic. Sex Transm Dis 35:197–202
Anderson CA, Boller AM, Richardson CJ et al (2004) Anal condyloma: a comparison between HIV positive and negative patients. Am Surg 70:1014–1018
Klencke B, Matijevic M, Urban RG et al (2002) Encapsulated plasmid DNA treatment for human papillomavirus 16-associated anal dysplasia: a Phase I study of ZYC101. Clin Cancer Res 8:1028–1037
Devaraj B, Cosman BC (2006) Expectant management of anal squamous dysplasia in patients with HIV. Dis Colon Rectum 49:36–40
Cubas R, Li M, Chen C, Yao Q (2007) Colorectal cancer: new advances in immunotherapy. Cancer Biol Ther 6:11–17
Stanley M, Lowy DR, Frazer I (2006) Prophylactic HPV vaccines: underlying mechanisms. Vaccine 24:S106–113
Huang CM (2008) Human papillomavirus and vaccination. Mayo Clin Proc 83:701–706
FUTURE II Study Group (2007) Prophylactic efficacy of a quadrivalent human papillomavirus (HPV) vaccine in women with virological evidence of HPV infection. J Infect Dis 196:1438–1446
Garland SM, Hernandez-Avila M, Wheeler CM et al (2007) Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med 356:1928–1943
Paavonen J, Jenkins D, Bosch FX et al (2007) Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet 369:2161–2170
Hildesheim A, Herrero R, Wacholder S et al (2007) Effect of human papillomavirus 16/18 L1 virus-like particle vaccine among young women with preexisting infection: a randomized trial. JAMA 298:743–753
Gambhira R, Gravitt PE, Bossis I et al (2006) Vaccination of healthy volunteers with human papillomavirus type 16 L2E7E6 fusion protein induces serum antibody that neutralizes across papillomavirus species. Cancer Res 66:11120–11124
Ohlschlager P, Pes M, Osen W et al (2006) An improved rearranged human papillomavirus type 16 E7 DNA vaccine candidate (HPV-16 E7SH) induces an E7 wildtype-specific T cell response. Vaccine 24:2880–2893
Garcia-Hernandez E, Gonzalez-Sanchez JL, Andrade-Manzano A et al (2006) Regression of papilloma high-grade lesions (CIN 2 and CIN 3) is stimulated by therapeutic vaccination with MVA E2 recombinant vaccine. Cancer Gene Ther 13:592–597
Kaufmann AM, Nieland JD, Jochmus I et al (2007) Vaccination trial with HPV16 L1E7 chimeric virus-like particles in women suffering from high grade cervical intraepithelial neoplasia (CIN 2/3). Int J Cancer 121:2794–2800
Koorstra JB, Hustinx SR, Offerhaus GJ, Maitra A (2008) Pancreatic carcinogenesis. Pancreatology 8:110–125
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Marin-Muller, C., Li, M., Chen, C. et al. Current Understanding and Potential Immunotherapy for HIV-Associated Squamous Cell Carcinoma of the Anus (SCCA). World J Surg 33, 653–660 (2009). https://doi.org/10.1007/s00268-008-9835-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-008-9835-y