Dr Rao on the Current Treatment Landscape in Localized Anal Cancer

“Anal cancer is a rare cancer, but the incidence has been increasing quite rapidly over the last few years in [both] the United Kingdom [and] globally. In the United States, there's been a noticeable rise. The mainstay of treatment [for localized disease] was actually formulated some time back based on a number of trials.”

Sheela Rao, MBBS, MD, FRCP, consultant medical oncologist in the Gastrointestinal Unity at the Royal Marsden Hospital, highlights the current treatment landscape for localized anal cancer on Anal Cancer Awareness Day, which is observed annually on March 21.

Although anal cancer is considered rare, the incidence has been increasing worldwide, including in the United Kingdom and in the United States, Rao begins. With a higher incidence, it is important to highlight mainstay treatments for localized anal cancer, which have been established through several clinical trials, she explains.

Regarding localized disease, common treatment had previously consisted of chemoradiation, as it demonstrated positive efficacy that could help cure most patients, she says. Therefore, surgery was less commonly used as a treatment option in the localized setting, Rao adds. She notes that these findings were based on data from notable clinical trials, including the ACT I and ACT II trials. Of note, the ACT I trial introduced chemoradiation as the new standard of care for patients with anal cancer. These studies evaluated a combination of chemotherapy with mitomycin and radiotherapy, which was delivered as a long course of treatment, she explains. Specifically, the ACT II study, which built off of the findings from ACT I, randomly assigned patients to receive mitomycin at 12 mg/m2 on day 1 or cisplatin at 60 mg/m2 on days 1 and 29, with fluorouracil at 1000 mg/m2 daily on days 1 to 4 and 29 to 32, along with radiation therapy at 50.4 Gy in 28 daily fractions.

Among patients on the respective trials, she emphasizes that the majority of patients had complete responses to chemoradiation. However, in some patients who had remaining disease after chemoradiation, surgery was their next form of treatment.

Now that many patients with anal cancer are surviving longer following treatment, Rao concludes that the next big question is how to continue improving outcomes for respective patients.