Metastatic anal cancer is not well studied in regard to chemo options for metastatic disease. 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. ”
I was not able to find credible literature supporting the use of Xeloda in this setting.Erbitux is a drug that is active in many different cancer typoes, both adenocarcinomas, f.e. of colon, and squamous, such as in head and neck. However, less is known about its rule for treatment of anal cancer or its role in combination with 5Fu, especially in the metastatic setting ( several combination therapies are lsited as being clinical trials for localized disease). NCCN lists only 5 Fu and cisplatin for metastatic anal cancer therapy. ESMO 2014 lists and mildly approves of single agent therapies second line.
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
Hainsworth, J.D., et al., 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): p. 642-9.
NCCN.ORG, Anal Cancer 2012
Uronis, Hope E. , Bendell, Johanna C. Anal Cancer: An Overview Oncologist 2007 12: 524-534