Cancer Treatment Today » Chemotherapy http://cancertreatmenttoday.org Knowledge is Power Thu, 26 Mar 2026 23:39:25 +0000 en-US hourly 1 Cisplatin and Xeloda for metastatic anal cancer – pro http://cancertreatmenttoday.org/cisplatin-and-xeloda-for-metastatic-anal-cancer-pro/ http://cancertreatmenttoday.org/cisplatin-and-xeloda-for-metastatic-anal-cancer-pro/#comments Fri, 14 Sep 2012 16:09:02 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=8849 Systemic chemotherapy remains the mainstay of treatment for patient with metastatic anal cancer. The National Comprehensive Cancer Network (NCCN) Guidelines currently recommend cisplatin and 5FU chemotherapy as first-line treatment of metastatic squamous cell carcinoma (SCC). This is largely based on a study of 19 patients treated with cisplatin 100 mg/m2 and infusional 5FU 1 gm/m2/day over 5 days with a 66% response rate; there was 1 complete response and 11 partial responses in addition to 4 patients with stable disease. The actuarial survival was 62.2% at 1 year and 32.2% at 5 years, and the median survival was 34.5 months]. There have also been a number of case reports demonstrating a benefit with the cisplatin/5FU combination. This is the best researched, although not extensively supported, regimen for anal cancer.

Recently the oral fluoropyrimidine capecitabine(Xeloda) has been substituted for 5FU in a number of solid tumours, and, extrapolating from this data, many oncologists use capecitabine with cisplatin rather than 5FU. This has a number of advantages for patients, including ease of administration and possibly greater efficacy. Unfortunately, however, there is no literature support for this substitution.

D. Cunningham, N. Starling, S. Rao et al., “Capecitabine and oxaliplatin for advanced esophagogastric cancer,” New England Journal of Medicine, vol. 358, no. 1, pp. 36–46, 2008.

P. Pfeiffer, J. P. Mortensen, B. Bjerregaard et al., “Patient preference for oral or intravenous chemotherapy: a randomised cross-over trial comparing capecitabine and Nordic fluorouracil/leucovorin in patients with colorectal cancer,” European Journal of Cancer, vol. 42, no. 16, pp. 2738–2743, 2006.

 Alice Dewdney and Sheela Rao Metastatic Squamous Cell Carcinoma of the Anus: Time for a Shift in the Treatment Paradigm? ISRN OncologyVolume 2012 (2012)

NCCN, Anal -6, 2012

See Lay version here

]]> http://cancertreatmenttoday.org/cisplatin-and-xeloda-for-metastatic-anal-cancer-pro/feed/ 0 Combined Resection for Anal Cancer – pro http://cancertreatmenttoday.org/combined-resection-for-anal-cancer-pro/ http://cancertreatmenttoday.org/combined-resection-for-anal-cancer-pro/#comments Fri, 03 Aug 2012 13:19:18 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=4156 While a combined resection of rectal cancer and partial hepatectomy are well established, the same is not the case for anal cancer. Metastatic anal cancer is not well studied in regard to combined resection. NCCN recommends only 5FU and cisplatin or cisplatin for metastatic anal cancer. A recent review states: ” Metastatic disease develops in 10%–17% of patients treated with chemoradiation therapy. The most common site of distant metastasis is the liver. There are limited published data on the use of chemotherapy, particularly newer agents, to treat metastatic anal carcinoma. Active agents include cisplatin plus 5-FU, carboplatin, doxorubicin, and semustine. Participation in a clinical trial should be discussed with all potentially eligible patients.”

Although there have been no randomized trials comparing surgery with radiation treatment or with combined chemoradiation, based on multiple studies and clinical experience for the last 20 years, there has been a substantial change in the management of epidermoid anal carcinomas, with more patients undergoing nonsurgical treatment.

I was not able to find credible literature supporting a combined resection approach for anal cancer. NCCN lists only 5 Fu and cisplatin for metastatic anal cancer therapy. The first report of this approach was by Tokar in 2006.

Principles and Practice of Gastrointestinal Oncology (Hardcover) by David P Kelsen (Editor), John M Daly (Editor), Scott E Kern (Editor), Bernard Levin Editor), Joel E Tepper (Editor) Publisher: Lippincott Williams & Wilkins; Second Edition edition (October 1, 2007), p.648 ISBN-13: 978-0781776172

NCCN.ORG, Anal Cancer 2012

Uronis, Hope E. , Bendell, Johanna C. Anal Cancer: An Overview Oncologist 2007 12: 524-534

Tokar M, Bobilev D, Zalmanov S, Geffen DB, Walfisch S. Combined multimodal approach to the treatment of metastatic anal carcinoma: report of a case and review of the literature. Onkologie. 2006 Feb;29(1-2):30-2.

Read the Layperson version here.

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