Metastatic anal canal squamous cell carcinoma in a patient with HIV treated with concomitant radiotherapy chemo. Case report and literature review
DOI:
https://doi.org/10.22516/25007440.290Keywords:
anal canal, neoplasms of the anus, squamous cell carcinoma, HIV, chemoradiotherapyAbstract
Anal canal carcinoma is responsible for up to 4% of all cases of colon, rectum and anus cancer. The most common histological type is squamous cell carcinoma. A non-negligible proportion of patients have metastasized by the time of diagnosis. In these stages the prognosis is poor, and treatment is usually based on palliative chemotherapy with cisplatin and 5-fluorouracil. Five year survival rates do not exceed 30%. Some recent studies have suggested that multidisciplinary chemoradiotherapy (chemotherapy combined with radiation therapy) in earlier stages of the disease could improve survival for a select group of patients.
We present the case of a 54-year-old male patient with squamous cell carcinoma of the anal canal with extensive metastasis who also had HIV. He was treated at an institution specializing in cancer treatment where complete remission of the disease was achieved after treatment with chemoradiotherapy with Mitomycin C and 5-fluorouracil. He remains in remission four years after discontinuation of treatment. We discuss the case and review the literature.
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Glynne-Jones R, Nilsson P, Aschele C, Goh V, Peiffert D, Cervantes A, et al. Anal cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Eur J Surg Oncol. 2014;40:1165-76. doi: https://doi.org/10.1016/j.ejso.2014.07.030.
Nelson R, Levine A, Bernstein L, Smith D, Lai L. Changing patterns of anal canal carcinoma in the United States. J Clin Oncol. 2013;31:1569-75. doi: https://doi.org/10.1200/JCO.2012.45.2524.
Oliveros R, Rey-León C, Olarte H, Ospina J, Villamizar J, Acosta M, et al. Carcinoma del ano: experiencia con 82 pacientes. Rev Col Cir. 1990;5(3):139-46.
Abbas A, Yang G, Fakih M. Management of anal cancer in 2010. Part 1: Overview, screening, and diagnosis. Oncology (Williston Park). 2010;24:364-9.
Glynne-Jones R. Chemotherapy, "Lighting the fire" or releasing the brakes" in metastatic anal cancer. Dis Colon Rectum. 2017;60(8):757-8. doi: https://doi.org/10.1097/DCR.0000000000000828.
National Comprehensive Cancer Network. Anal carcinoma. V.1.2018. Último acceso:24 de mayo de 2018. Disponible en: https://www.nccn.org/professionals/physician_gls/pdf/anal.pdf (nota del corrector: el link no lleva al documento, revisar).
Sclafani F, Morano F, Cunningham D, Baratelli C, Kalaitzaki E, Watkins D, et al. Platinum-fluoropyrimidine and paclitaxel-based chemotherapy in the treatment of advanced anal cancer patients. Oncologist. 2017;22(4):402-8. doi: https://doi.org/10.1634/theoncologist.2016-0241.
Eng C, Chang G, You Y, Das P, Bigas M, Xing Y, et al. The role of systemic chemotherapy and multidisciplinary management in improving the overall survival of patients with metastatic squamous cell carcinoma of the anal canal. Oncotarget. 2014;5:11133-42. doi: https://doi.org/10.18632/oncotarget.2563.
Edge S, Byrd D, Compton C, Fritz A, Greene F, Trotti A. AJCC cancer staging manual. New York, NY: Springer. 2009.
Shridhar R, Shibata D, Chan E, Thomas C. Anal cancer: current standards in care and recent changes in practice. CA Cancer J Clin. 2015;65(2):139-62. doi: https://doi.org/10.3322/caac.21259.
Eng C, Pathak P. Treatment options in metastatic squamous cell carcinoma of the anal canal. Curr Treat Options Oncol. 2008;9(4-6):400-7. doi: https://doi.org/10.1007/s11864-009-0103-7.
Faivre C, Rougier P, Ducreux M, Mitry E, Lusinchi A, Lasser P, et al. 5-fluorouracil and cisplatin combination chemotherapy for metastatic squamous-cell anal cancer. Bull Cancer. 1999;86(10):861-5.
Pathak P, King BT, Ohinata A, Das P, Crane CH, Chase JL, et al. The treatment of metastatic squamous cell carcinoma (SCCA) of the anal canal: a single institution experience. In ASCO Gastrointestinal Cancers Symposium: Multidisciplinary Approaches to the Prevention, Diagnosis, and Therapy of GI Cancers. 2008.
Kim R, Byer J, Fulp W, Mahipal A, Dinwoodie W, Shibata D. Carboplatin and paclitaxel treatment is effective in advanced anal cancer. Oncology. 2014;87:125-32. doi: https://doi.org/10.1159/000361051.
Hainsworth J, Burris H 3rd, Meluch A, Baker M, Morrissey L, Greco F. Paclitaxel, carboplatin, and long-term continuous infusion of 5-fluorouracil in the treatment of advanced squamous and other selected carcinomas: results of a Phase II trial. Cancer. 2001;92(3):642-9. doi: https://doi.org/10.1002/1097-0142(20010801)92:3<642::AID-CNCR1365>3.0.CO;2-Z.
Jhawer M, Mani S, Lefkopoulou M, Hanh R, Harris J, Catalano P, et al. Phase II study of mitomycin-C, adriamycin, cisplatin (MAP) and bleomycin-CCNU in patients with advanced cancer of the anal canal: an eastern cooperative oncology group study E7282. Investig New Drugs. 2006;24(5):447-54. doi: https://doi.org/10.1007/s10637-006-7667-x.
Rogers J, Crane C, Das P, Delclos M, Gould S, Ohinata A, et al. Definitive chemoradiation in oligometastatic squamous cell carcinoma of the anal canal. Gastrointest Cancer Res. 2014;7(2):65-8.
Sclafani F, Adams R, Eng C, Benson A, Glynne-Jones R, Sebag-Montefiore D, et al. Inter AACT: an international multicenter open label randomized phase II advanced anal cancer trial comparing cisplatin (CDDP) plus 5-fluorouracil (5-FU) versus carboplatin (CBDCA) plus weekly paclitaxel (PTX) in patients with inoperable locally recurrent (ILR) or metastatic disease. J Clin Oncol. 2015;33(3):TPS792. doi: https://doi.org/10.1200/jco.2015.33.3_suppl.tps792.
Bryant A, Huynh-Le M, Simpson D, Gupta S, Sharabi A, Murphy J. Association of HIV status with outcomes of anal squamous cell carcinoma in the era of highly active antiretroviral therapy. JAMA Oncol. 2018;4(1):120-2. doi: https://doi.org/10.1001/jamaoncol.2017.2844.
Hoffman R, Welton M, Klencke B, Weinberg V, Krieg R. The significance of pretreatment CD4 count on the outcome and treatment tolerance of HIV-positive patients with anal cancer. Int J Radiat Oncol Biol Phys. 1999;44(1):127-31. doi: https://doi.org/10.1016/S0360-3016(98)00528-8.
Kauh J, Koshy M, Gunthel C, Joyner M, Landry J, Thomas C Jr. Management of anal cancer in the HIV-positive population. Oncology (Williston Park). 2005;19(12):1634-938.
Stadler R, Greorcyk S, Euhus D, Place R, Huber P, Simmang C. Outcome of HIV-infected patients with invasive squamous-cell carcinoma of the anal canal in the era of highly active antiretroviral therapy. Dis Colon Rectum. 2004;47:1305-9. doi: https://doi.org/10.1007/s10350-004-0584-1.
Wang C, Sparano J, Palefsky J. Human immunodeficiency virus/AIDS, human papillomavirus, and anal cancer. Surg Oncol Clin N Am. 2017;26:17-31. doi: https://doi.org/10.1016/j.soc.2016.07.010.
Ishida Y, Agata Y, Shibahara K, Honjo T. Induced expression of PD-1, a novel member of the immunoglobulin gene superfamily, upon programmed cell death. EMBO J. 1992;11:3887-95. doi: https://doi.org/10.1002/j.1460-2075.1992.tb05481.x.
Leach D, Krummel M, Allison J. Enhancement of antitumor immunity by CTLA-4 blockade. Science. 1996;271:1734-6. doi: https://doi.org/10.1126/science.271.5256.1734.
Ott P, Piha-Paul S, Munster P, Pishvaian M, van Brummelen E, Cohen R, et al. Safety and antitumor activity of the anti-PD-1 antibody pembrolizumab in patients with recurrent carcinoma of the anal canal. Ann Oncol. 2017;28(5):1036-41. doi: https://doi.org/10.1093/annonc/mdx029.
Morris V, Salem M, Nimeiri H, Igbal S, Singh P, Ciombor K, et al. Nivolumab for previously treated unresectable metastatic anal cancer (NCI9673): a multicenter, single-arm, phase 2 study. Lancet Oncol. 2017;18(4):446-53. doi: https://doi.org/10.1016/S1470-2045(17)30104-3.
Kim D, Byer J, Kothari N, Mahipal A, Chang Y, Kim R. EGFR inhibitors in patients with advanced squamous cell anal carcinomas: a single-institution experience. Oncology. 2017;92(4):190-6. doi: https://doi.org/10.1159/000452766.
Casadei A, Passardi A, Fornaro L, Rosetti P, Valgiusti M, Ruscelli S, et al. Treatment of squamous cell carcinoma of the anal canal: A new strategies with anti-EGFR therapy and immunotherapy. Crit Rev Oncol Hematol. 2018;123:52-6. doi: https://doi.org/10.1016/j.critrevonc.2018.01.007.
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