Efficacy of Cetuximab in Combination with FOLFIRI in a Patient with KRAS Wild-Type Metastatic Anal Cancer

Abstract

Anal canal cancer is a rare tumor without clear treatment evidence in the metastatic setting. In terms of the bad prognosis of patients with metastatic anal cancer, further therapeutic options are urgently needed. In this paper we present the case of a 64-year-old man suffering from undifferentiated squamous cell carcinoma with liver metastases. After progression on cisplatin and fluorouracil, tumor tissue was analyzed with respect to anti-EGFR therapy with cetuximab. There was no KRAS mutation and the EGFR expression level in the tumor tissue was 2+; ideal conditions for the immunotherapy. Encouraged by these results we started a therapy using FOLFIRI in combination with cetuximab. Fortunately the patient showed a partial response after 6 cycles. On patient’s preference we did a therapy break of 6 weeks. Within this time period the disease was progressive indicating its aggressiveness. However, the same immunotherapy was able to stabilize the disease for a further 3 months. The patient died 21 months after diagnosis because of liver failure. Nevertheless, from our perspective the combination of FOLFIRI and cetuximab is quite a promising therapeutic option for patients with metastatic anal cancer. Potential predictive factors of the immunochemotherapy are discussed in this paper.

EGFR Inhibitors in Patients with Advanced Squamous Cell Anal Carcinomas: A Single-Institution Experience

“…Severe skin rash (grade 3/4) has been reported in 5-20% of patients who receive cetuximabbased treatment [24] . In contrast, no severe skin toxicities were observed in this study (only grade 1/2 rash of 39%), which is consistent with previous case and case series reports of cetuximab monotherapy or cetuximab combined with chemotherapy in metastatic SCCA [6,[13][14][15] . One possible explanation for the lack of severe skin toxicities is the limited number of patients in our study.…”

“…A number of previous studies have demonstrated universal expression of EGFR in anal squamous cell carcinomas [7,8,11] , and several case studies showed clinical efficacy of EGFR inhibitors in patients with metastatic anal cancer [6,[12][13][14][15] . However, these successes with targeting EGFR remain anecdotal due to the limited number of patients in each case study.…”

The prognostic significance of epidermal growth factor receptor expression in patients with anal carcinoma

“…Similarly, yet another study demonstrated high toxicity of cetuximab therapy [42]. At present, evaluation of any benefit of cetuximab or panitumumab in the therapy of metastatic anal cancer is available mostly in the form of case reports [39,[43][44][45]. As mentioned above, worse tolerance of the therapy is a problem in the combination of antiEGFR therapy and chemoradiotherapy.…”

Cancers of the Anal Canal: Diagnosis, Treatment and Future Strategies

“…Cetuximab is a monoclonal antibody against the EGFR and, in combination with systemic chemotherapy, has been shown to reduce size of liver metastases in advanced disease [104,105]. While the high rate of EGFR expression and low KRAS mutation rate makes the use of EGFR inhibitors attractive, there is little published work in this area.…”