Successful Treatment of Metastatic Anal Canal Adenocarcinoma with mFOLFOX6 + Bevacizumab

Abstract

Anal canal adenocarcinoma is a relatively rare malignancy without established diagnostic and treatment criteria. Case reports of chemotherapy for anal canal adenocarcinoma with distant metastasis are limited, and there is no convincing evidence for treatment effectiveness. A 62-year-old man complained of difficulty in defecation, anal pain, and bleeding during bowel movement. He was diagnosed with moderately differentiated primary anal canal adenocarcinoma. A computed tomography scan revealed multiple metastases in the lung and liver. The patient was treated with abdominoperineal resection to control local tumor growth and then with chemotherapy consisting of mFOLFOX6 + bevacizumab. Because he had an activating KRAS mutation, anti-EGFR therapy was not considered. A reduction in the size of lung and liver metastases was observed after 4 courses of mFOLFOX6 + bevacizumab, and after 22 courses, maximum reduction in the metastatic lesions was achieved. The patient demonstrated tolerable levels of oxaliplatin-related peripheral neurotoxicity (grades 1-2) and was considered as having partial response to treatment. He is currently at the partial response state for 1 year. We plan to continue the treatment unless the patient develops progressive disease or intolerable adverse reactions. This case demonstrates that anal canal adenocarcinoma with distant metastases could be successfully treated with mFOLFOX6 + bevacizumab therapy according to the guidelines for rectal carcinoma. However, as anal canal carcinoma has multiple histological subtypes, it is important to establish subtype-specific treatment strategies.

Anal Carcinoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

“…The safety of FOLF-OX in patients with anal cancer has been demonstrated in a case report. 124 Despite the limited data for FOLFOX in this setting, the panel added it based on consensus and its current use as a standard option at many NCCN Member Institutions.…”

Squamous rectal carcinoma: a rare malignancy, literature review and management recommendations

“…20 With no single evidence of the best systemic treatement in the setting of metastatic rSCC, chemotherapy based on the principles of metastatic aSCC (5-FU þ cisplatin or carboplatin þ paclitaxel or 5-FU þ oxaliplatin) should be considered for those cases. 48,49 TREATMENT EVALUATIONeFOLLOW-UPeRECURRENCE As with rADC and aSCC, one of the most pertinent issues with CRT is determining treatment response, which currently can only be confirmed by histopathology. 50 A suspicious residual mass or scar should be considered for selective biopsy.…”

“… 20 With no single evidence of the best systemic treatement in the setting of metastatic rSCC, chemotherapy based on the principles of metastatic aSCC (5-FU + cisplatin or carboplatin + paclitaxel or 5-FU + oxaliplatin) should be considered for those cases. 48 , 49 …”

Research on Anal Squamous Cell Carcinoma: Systemic Therapy Strategies for Anal Cancer

“…In this setting, guidelines have historically recommended a platinum doublet including a fluoropyrimidine as first-line treatment [ 28 , 29 ]. There are limited data supporting the use of leucovorin, fluorouracil and oxaliplatin (FOLFOX) as well as FOLFCIS, effectively a FOLFOX schedule with cisplatin replacing oxaliplatin [ 30 , 31 ]. Nonetheless, until 2018, treatment recommendations have been based upon similar case series and retrospective studies.…”