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The Role of Immunotherapy in the Treatment of Anal Cancer and Future Strategies

  • Lower Gastrointestinal Cancers (AB Benson, Section Editor
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Despite being markedly sensitive to chemoradiotherapy, patients with locally advanced (T3-4 and/or node-positive) squamous cell carcinoma of the anal canal (SCCA) still present high rates of disease recurrence, which is characterized by meaningful morbidity and mortality. Abdominoperineal resection as salvage surgery may be considered for patients with local recurrence, but with an important negative impact in the quality of life. Systemic therapy of advanced SCCA is an unmet clinical need. Palliative chemotherapy for the management of unresectable or metastatic disease yields approximately 60% of objective response rate; however, it still portends a grim prognosis. Based on the recently published InterAACT trial, carboplatin plus paclitaxel has become the standard of care of advanced disease; modified DCF (docetaxel, cisplatin, and 5-fluorouracil) may also be considered for fit patients amenable to intensive therapy. There are no FDA-approved therapies for the treatment of chemorefractory patients. Nevertheless, both nivolumab and pembrolizumab may be considered for these patients with promising results, regardless of PD-L1 expression or other predictive biomarkers. It is estimated that approximately 1 out of 5 patients with SCCA will derive large benefit from PD-1 inhibitors, which may produce considerable durations of response. Ongoing clinical trials exploring the combination of chemotherapy plus immune checkpoint inhibitors in the first-line therapy, combination of anti-PD-1/PD-L1 plus anti-CTLA-4, and emerging immunotherapeutic approaches, such as adoptive T cell therapies, are eagerly awaited and may bring practice-changing results in the next few years for the treatment of this challenging disease.

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Authors and Affiliations

  1. Department of Gastrointestinal Medical Oncology, Oncoclinicas, Rua Roma, 561, Belo Horizonte, MG, 30360-680, Brazil

    Alexandre A. Jácome MD, PhD

  2. Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 426, Houston, TX, 77030, USA

    Van Karlyle Morris MD

  3. Vanderbilt-Ingram Cancer Center, 2220 Pierce Avenue, 777 Preston Research Building, Nashville, TN, 37232, USA

    Cathy Eng MD, FASCO

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  1. Alexandre A. Jácome MD, PhD
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  2. Van Karlyle Morris MD
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  3. Cathy Eng MD, FASCO
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Correspondence to Cathy Eng MD, FASCO.

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Alexandre A. Jácome declares that he has no conflict of interest. Van Karlyle Morris has received research funding (paid to his institution) from Bristol-Myers Squibb. Cathy Eng declares that she has no conflict of interest.

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Jácome, A.A., Morris, V.K. & Eng, C. The Role of Immunotherapy in the Treatment of Anal Cancer and Future Strategies. Curr. Treat. Options in Oncol. 23, 1073–1085 (2022). https://doi.org/10.1007/s11864-022-00939-3

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