Combined Multimodal Approach to the Treatment of Metastatic Anal Carcinoma: Report of a Case and Review of the Literature

Tokar, Margarita; Bobilev, Dmitri; Zalmanov, Svetlana; Geffen, David; Walfisch, Shlomo

doi:10.1159/000089798

Cited by 19 publications

(12 citation statements)

References 16 publications

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“…In most of these reports cisplatin was used as backbone of treatment resulting in response rates of about 50% and median overall survival of 15–33 months depending on patient selection. In single patients, an aggressive multimodality approach including resection of (liver) metastases, irradiation of para-aortic lymph nodes or intra-arterial chemotherapy provided long-term survival [11,12]. The largest prospective clinical trial published thus far was conducted by the Eastern Cooperative Group (ECOG) [10].…”

Section: Introductionmentioning

confidence: 99%

Cetuximab-Based Treatment of Metastatic Anal Cancer: Correlation of Response with KRAS Mutational Status

Lukan¹,

Ströbel²,

Willer

et al. 2009

Oncology

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Background: No standard chemotherapy regimen can be defined for patients with metastatic squamous cell carcinoma of the anus due to the low incidence of this disease and the high cure rate of localized tumors. Anal cancers universally express the epidermal growth factor receptor (EGFR) and KRAS mutations have not been reported in anal cancer thus far. Methods: We report on 7 patients with metastatic anal cancer treated with cetuximab – a chimeric antibody against EGFR – on a compassionate use basis along with the results of KRAS mutational analysis. Results: Marked tumor shrinkage was noted in several patients using cetuximab monotherapy or cetuximab/irinotecan combination as first or subsequent treatment line (usually after failure of cisplatin-based regimens). Two out of seven patients harbored KRAS mutations. Both patients had progressive disease receiving cetuximab, while the remaining 5 patients had either a partial remission (n = 3), a minor remission (n = 1) or no change lasting ≥6 months after previous rapid tumor progression. Conclusion: Cetuximab-based treatment appears to be a valuable treatment option for patients with metastatic KRAS wild-type anal cancer after failure of or as an alternative to cisplatin/5-fluorouracil-based therapy.

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Section: Introductionmentioning

confidence: 99%

Cetuximab-Based Treatment of Metastatic Anal Cancer: Correlation of Response with KRAS Mutational Status

Lukan¹,

Ströbel²,

Willer

et al. 2009

Oncology

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“…Two and 5 years after presentation, the patient underwent repeated partial hepatectomies for recurrent liver disease. Five months after completing therapy and 71 months after the initial diagnosis, she remained in good health with no evidence of disease (13).…”

Section: Discussionmentioning

confidence: 95%

Successful hepatectomy for metastatic squamous cell carcinoma of the anal canal—a case report

Sousa

Santos

Belotto

et al. 2016

J. Gastrointest. Oncol.

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Abstract:Despite rare, metastatic anal carcinoma confers a poor prognosis. Systemic chemotherapy is the mainstay of treatment for advanced disease while the role of biologics and/or surgical resection of metastatic disease are anecdotal. Compared to isolated liver colorectal or neuroendocrine cancer liver metastases, there is far less experience with resection or nonsurgical local ablative procedures for patients with metastatic anal carcinoma to the liver. We report the case of a 67-year-old woman with metastatic anal carcinoma to the liver who was successfully treated with liver resection and remains free of relapse more than one year later. pelvis, which showed a 5.1-cm anal canal lesion as well as enlarged bilateral inguinal lymph nodes (2.0 cm), consistent with a clinical stage IIIB. At that time, the patient was treated with standard chemoradiation (CRT) consisting of mitomycin C (12 mg/m 2 , given on day 1) and Capecitabine (825 mg/m 2 twice daily during the days of radiotherapy). KeywordsThe total radiation therapy dose was 54 Gy in 27 fractions. During CRT, she developed grade 3 cutaneous radiation dermatitis and grade 3 diarrhea. Clinical examination four weeks after finishing CRT revealed complete regression of the anal tumor with no palpable inguinal lymphadenopathy. Nevertheless, 4 months after the completion of CRT, she developed at least three metastatic liver lesions in segments V and VI, measuring approximately 3.6 cm each. She was treated with 6 cycles of weekly Paclitaxel (80 mg/m²) and Cetuximab (400 mg/m² in the first cycle followed by 250 mg/m²). A repeat CT scan as well as a PET-CT scan revealed considerable increase in the size of the larger liver mass, which measured 13.1 cm × 10.7 cm × 10.6 cm, without new metastases (Figures 1 and 2). At that point, the patient was complaining of intense fatigue, anorexia, as well as upper abdominal pain. She was confined to bed with an extremely poor quality of life. Her lactate dehydrogenase (LDH) level was 1,045 U/L (normal values: 180-460 U/L). After extensive discussion with the patient and her family, it was decided to proceed with right hepatectomy. The postoperative period was uncomplicated and the patient was discharged home six days later. Histological findings of the resected specimen demonstrated metastatic squamous cell carcinoma with extensive necrosis, consistent with the known primary tumor of the anal canal, with free margins. Thirteen months after surgery, the patient remains remarkably well and free of recurrence (Figures 3 and 4). DiscussionIn patients with primary tumors of the gastrointestinal tract (especially colorectal adenocarcinoma and small intestine neuroendocrine tumors), the most likely mode of spread to the liver is through portal venous drainage or via direct intra-abdominal lymphatic channels. For other primary malignancies, metastases commonly reach the liver via systemic circulation, implying that extra-hepatic sites may have the same probability of being involved. Based on this rationale, hepatic resection of non-co...

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“…Some studies have shown a good response of the disease to a combination of systemic chemotherapy and regional control of hepatic lesions either through resection [22,23] or through intraarterial chemotherapy [11•]. A case report by Gurfinkel et al noted that a patient proceeded to receive neoadjuvant 5-FU and cisplatin and underwent hepatic resection of segments 3 and 6.…”

Section: Biologic Therapymentioning

confidence: 99%

Treatment Options in Metastatic Squamous Cell Carcinoma of the Anal Canal

Eng

Pathak

2008

Curr. Treat. Options in Oncol.

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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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Combined Multimodal Approach to the Treatment of Metastatic Anal Carcinoma: Report of a Case and Review of the Literature

Cited by 19 publications

References 16 publications

Cetuximab-Based Treatment of Metastatic Anal Cancer: Correlation of Response with KRAS Mutational Status

Cetuximab-Based Treatment of Metastatic Anal Cancer: Correlation of Response with KRAS Mutational Status

Successful hepatectomy for metastatic squamous cell carcinoma of the anal canal—a case report

Treatment Options in Metastatic Squamous Cell Carcinoma of the Anal Canal

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