Recurrent metastatic anal cancertreated with modified paclitaxel,ifosfamide, and cisplatin and third-linemitomycin/cetuximab

摘要

Purpose: Squamous cell carcinoma represents approximately 75% of all anal cancers. Squamous cell carcinoma of theanal canal is a rare malignancy often curable in the early stages with the combined modality therapy of chemoradiation.Treatment in the metastatic setting is challenging due to the rarity of metastatic disease with the majority of patientspresenting with curative locally advanced disease, and the ability to design clinical trials for metastatic disease has yet tobe explored. There are no established chemotherapy guidelines for patients with metastatic anal cancer after the failureof cisplatin and fluorouracil. Methods: We used PubMed and OVID research engines to identify publications in English literature addressing treat-ments/therapeutics using the following keywords "metastatic anal cancer" and "metastatic squamous cell carcinoma ofanus" in addition to reviewing related clinical trials in clinicaltrials.gov. Results: We hereby report our experience in using aggressive combinations in the second- and third-line settings. A49-year-old white male diagnosed with T3 N3 MO Stage 1MB anal cancer was treated initially with surgical excision andadjuvant fluorouracil/cisplatin due unavailability of mitomycin. He developed metastatic disease to the skin and perianalregion, was treated with four cycles of paclitaxel, ifosfamide, and cisplatin with growth factor support, and achievedminimal residual disease. On progression five months after finishing therapy, we treated him with mitomycin andcetuximab with mixed response after two cycles. The patient later elected to proceed with hospice care only andsuccumbed to his disease 16 months after first cycle of paclitaxel, ifosfamide, and cisplatin and 24 months from diagnosis.Conclusions: Paclitaxel, ifosfamide, and cisplatin is highly active in metastatic setting in selected patients. Cetuximabbased regimen can be valuable option as second or third line. Paclitaxel, ifosfamide, and cisplatin and mitomycin andcetuximab can be available options for unmet need in metastatic anal cancer.