Opinion statement
Squamous cell carcinoma of the anal canal is a rare malignancy that is often cured with the combined modality therapy of chemoradiation. Yet, a minority of patients will develop distant metastatic disease, an area of oncology in which a universally accepted approach has not been determined. Consideration of platinum-based systemic chemotherapy is commonly provided for palliation with the optimal duration of therapy being largely unknown; the role of biologics and/or surgical resection of metastatic disease are anecdotal. Patients with no contraindications to systemic chemotherapy should be treated aggressively with consideration of multidisciplinary management if appropriate. Here, we present a summary of the existing literature in the treatment of metastatic anal carcinoma in the hopes of providing insight and potential treatment alternatives for the practicing physician.
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Ries LAG, Melbert D, Krapcho M, Stinchcomb DG, Howlader N, Horner MJ, Mariotto A, Miller BA, Feuer EJ, Altekruse SF, Lewis DR, Clegg L, Eisner MP, Reichman M, Edwards BK (eds): SEER Cancer Statistics Review, 1975–2005. Bethesda, MD: National Cancer Institute, 2003
Johnson LG, Madeline MM, Newcomer LM et al. Anal cancer incidence and survival: the surveillance, epidemiology and end-result experience, 1973-2000. Cancer. 2001; 101: 281-288.
Eng, C (2006) Anal cancer: current and future methodology. Cancer Invest. 24(5):535-44.
Bedimo R. Non-AIDS-defining malignancies among HIV-infected patients in the highly active antiretroviral therapy era. Curr HIV/AIDS Rep. 2008 Aug; 5(3):140-9.
Ryan DP, Compton CC, Mayer RJ. Carcinoma of the anal canal. N Engl J Med 2000; 342(11):792-800.
Das P, Bhatia S, Eng C, Ajani JA, Skibber JM, Rodriguez-Bigas MA, et al. (2007) Predictors and patterns of recurrence after definitive chemoradiation for anal cancer. Int J Radiat Oncol Biol Phys 68(3):794-800.
Hoffman R, Welton ML, Klencke B, Weinberg V, Krieg R. The significance of pretreatment CD4 count on the outcome and treatment tolerance of HIV-positive patients with anal cancer. Int J Radiat Oncol Biol Phys. 1999; 44(1):127-31.
UKCCCR Anal Canal Cancer trial Working Party: Epidermoid anal cancer: Results from the UKCCCR randomized trial of radiotherapy alone versus radiotherapy, 5-fluorouracil and mitomycin C. Lancet 1996, 348:1049–1054.
Cummings BJ. Metastatic anal cancer: the search for cure. Onkologie 2006; 29:5-6.
Tanum G, Tveit K, Karlsen KO, Hauer Jensen M. Chemotherapy and radiation therapy for anal carcinomas. Cancer 1991; 67:2462-2466.
Ajani JA, Carrasco CH, Jackson DE, Wallace S: Combination of cisplatin plus fluoropyrimidine chemotherapy effective against liver metastases from carcinoma of the anal canal. Am J Med 1989; 87(2):221–224.
Faivre C. Rougier P. Ducreux M. Mitry E. Lusinchi A. Lasser P. Elias D. Eschwege F. 5-Fluorouracil and cisplatinum combination chemotherapy for metastatic squamous-cell anal cancer. Bull Cancer 1999; 86(10):861-5.
Alcindor T. Activity of paclitaxel in metastatic squamous anal carcinoma. Int J Colorectal Dis. 2008; 23(7):717.
Hainsworth JD, Burris HA III, Meluch AA, Baker MN, Morrissey LH, Greco FA. Paclitaxel, carboplatin, and long-term continuous infusion of 5-fluorouracil in the treatment of advanced squamous and other selected carcinomas: results of a Phase II trial. Cancer. 2001; 92(3):642-9.
Evans TRJ, Mansi JL, Glees JP. Response of metastatic anal carcinoma to single agent carboplatin. Clin Oncol 1993; 5:57-58.
Cunningham D, Humblet Y, Siena S, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med 2004; 351:337–45.
Di Fiore F, Blanchard F, Charbonnier F, Le Pessot F, Lamy A, Galais MP, Bastit L,, Sesboüé R, Tuech JJ, Queuniet AM, Paillot B, Sabourin JC, Michot F, Michel P, Frebourg T. Clinical relevance of KRAS mutation detection in metastatic colorectal cancer treated by Cetuximab plus chemotherapy. Br J Cancer. 2008;99(3):551-2.
Van Damme N, Van Roy N, Speleman F, Bols A, Van Dorpe J, Pauwels P, Peeters M: EGFR and K-RAS gene status evaluation in anal canal squamous cell carcinoma. J Clin Oncol 2008, 26(May 20 suppl; abstr. 15569)
Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J, Ove R, Kies MS, Baselga J, Youssoufian H, Amellal N, Rowinsky EK, Ang KK. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med. 2006; 354(6):634-6.
Phan LK, Hoff PM. Evidence of clinical activity for cetuximab combined with irinotecan in a patient with refractory anal canal squamous-cell carcinoma: report of a case. Dis Colon Rectum. 2007; 50(3):395-8.
Chao C, Goldberg M, Hoffman JP. Surgical salvage therapy: abdominopereneal resection for recurrent anal carcinoma, metastatectomy of recurrent colorectal cancer, and esophagostomy after combined chemoradiation. Curr Opin Oncol 2000;12(4):353-356.
Gurfinkel R, Walfisch S. Combined treatment of basaloid anal carcinoma using cisplatin, 5-fluorouracil and resection of hepatic metastasis. Tech Coloprotocol. 2005;9:235-236.
Tokar M, Bobilev D, Zalmanov S, Geffen DB, Walfisch S: Combined multimodal approach to the treatment of metastatic anal carcinoma: report of a case and review of the literature. Onkologie 2006;29:30-32.
Pawlik TM, Gleisner AL, Bauer TW, Adams RB, Reddy SK, Clary BM, Martin RC, Scoggins CR, Tanabe KK, Michaelson JS, Kooby DA, Staley CA, Schulick RD, Vauthey JN, Abdalla EK, Curley SA, Choti MA, Elias D. Liver-directed surgery for metastatic squamous cell carcinoma to the liver: results of a multi-center analysis. Ann Surg Oncol. 2007;14(10):2807-16.
Pathak P, King BT, Ohinata A, Das P, Crane CH, Chase JL, Eng C: The treatment of metastatic squamous cell carcinoma (SCCA) of the anal canal: a single institution experience. In ASCO Gastrointestinal Cancers Symposium: Multidisciplinary Approaches to the Prevention, Diagnosis, and Therapy of GI Cancers (#A352), 2008
Eng C, Crane CH, Rosner GL, Rodriguez-Bigas MA, Skibber JM, Bogaard KR, Lassere YM, Hoff PM, Lin EH, Abbruzzese JL: A phase II study of capecitabine plus oxaliplatin and radiation therapy, XELOX-XRT, in locally advanced squamous cell carcinoma of the anal canal: a preliminary toxicity analysis. In Gastrointestinal Cancers Symposium: Multidisciplinary Approaches to the Prevention, Diagnosis, and Therapy of GI Cancers (A216), 2005
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Eng, C., Pathak, P. Treatment Options in Metastatic Squamous Cell Carcinoma of the Anal Canal. Curr. Treat. Options in Oncol. 9, 400–407 (2008). https://doi.org/10.1007/s11864-009-0103-7
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DOI: https://doi.org/10.1007/s11864-009-0103-7