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- Title
Management of anal cancer in Latin America.
- Authors
Aguilar, Patrícia B.; Peixoto, Renata; Lim, Fiona; Wan, Bo Angela; Silva, Maurício F.
- Abstract
Squamous cell carcinoma (SCC) of the anus is a rare disease. Combined chemoradiotherapy has emerged as the preferred method of treatment because it can cure many patients while preserving the anal sphincter. Concurrent use of 5-fluorouracil (5-FU) plus mitomycin during radiotherapy (RT) rather or 5-FU plus cisplatin is the most commonly used scheme. Treatment response should be initially assessed clinically 8 to 12 weeks after completion of chemoradiotherapy. Based upon the results from the ACT-II trial, patients with persistent disease can be watched for up to six months following completion of chemoradiotherapy as long as there is no progression during this period of follow-up. For patients with evidence of progressive disease at any point or persisting disease at 26 weeks after completion of combined modality therapy and no evidence of metastatic disease, surgical treatment is recommended. Systemic chemotherapy is appropriate for the rare patient who develops metastatic disease. Although few data are available to guide the choice of regimen, first line therapy usually consists of cisplatin plus 5-FU. For patients with chemotherapy-refractory metastatic SCC of the anus, a trial of pembrolizumab or nivolumab, which are directed against the programmed cell death receptor 1 (PD-1), may be a newer option preferably used within the context of a clinical trial. However, in our view, neither PD-1 nor programmed cell death ligand 1 overexpression should be used to select patients for these treatments.
- Subjects
LATIN America; ADJUVANT treatment of cancer; CISPLATIN; COMBINED modality therapy; FLUOROURACIL; ANAL tumors; MITOMYCINS; CHEMORADIOTHERAPY
- Publication
Journal of Pain Management, 2019, Vol 12, Issue 4, p333
- ISSN
1939-5914
- Publication type
Article