Anal cancer: diagnosis and treatment - PowerPoint Presentation

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Anal cancer: diagnosis and treatment

Last updated:

June 2020

Introduction

This chapter provides

A review of how anal cancer is

diagnosed using a biopsy, and the role of staging in informing the treatment decision and predicting prognosisAn overview of recommended treatment approaches, and how CRT is the mainstay of treatmentA discussion of the recent developments and unmet needs in the treatment of anal cancer, such as the use of immunotherapies

CRT, chemoradiotherapy.

Biopsies and imaging are used to diagnose and stage anal cancer

1. Glynne-Jones R, et al. Radiother Oncol 2014;111(3):330



9.CT, computed tomography; FDG, fluorodeoxyglucose; MRI, magnetic resonance imaging; PET, positron emission tomography; TNM, tumor-node-metastasis.

TNM classification of anal cancer

1

1. AJCC Cancer Staging Manual, Eighth

Edition, last updated 2018. AJCC Cancer Staging Form Supplement. https://cancerstaging.org/references-tools/deskreferences/Documents/AJCC%20Cancer%20Staging%20Form%20Supplement.pdf (Accessed June 2020).*Previously termed carcinoma in situ, Bowen disease, anal intraepithelial neoplasia II-III, high-grade anal intraepithelial neoplasia. †The terms pM0 and MX are not valid categories in the TNM system. Assignment of the M category for clinical classification may be cM0, cM1, or pM1. Any of the M categories (cM0, cM1, or pM1) may be used with pathological stage grouping.

FNA, fine needle aspiration; SLN, sentinel lymph node; TNM

, tumor-node-metastasis.

The stage of anal cancer lesions is a prognostic indicator for five-year relative survival

1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. https://seer.cancer.gov/statfacts/html/anus.html

(

Accessed: June 2020).Adapted from Cancer Stat Facts 20102016 (SEER data).1

The size and extent of anal cancer lesions predicts prognosis

1

.

Salati SA, et al. Int J Health Sci (Qassim) 2012;6(2):20630; 2. Symer MM, et al. F1000Res 2018;7:F1000 Faculty Rev-1572.*Survival after salvage resection is possible, but this generally portends a poor prognosis.2

Overview of NCCN recommendations for the treatment of metastatic anal cancer

1. National Comprehensive Cancer

Network. NCCN

Clinical Practice Guidelines in Oncology. Anal Carcinoma, version 1.2020. November 2019. [https://www.nccn.org/professionals/physician_gls/default.aspx] (Accessed: June 2020).*Only chemotherapy is recommended for first-line treatment of metastatic disease following complete remission of locoregional disease or progressive disease.5-FU, 5-fluorouracil; DCF, docetaxel, cisplatin, flurouracil; FOLFCIS, folinic acid, fluorouracil, cisplatin; FOLFOX, folinic acid, fluorouracil, oxaliplatin; NCCN, National Comprehensive Cancer Network; RT,

radiotherapy.

Please refer to the guidelines for full recommendations

Unmet needs remain in the treatment of anal cancer

1. Sodergren SC, et al. Clin Oncol (R Coll Radiol) 2019;31(2):69



71; 2. Johnson B, et al. Clin Adv Hematol 2017;15(12):9681; 3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Anal Carcinoma, version 1.2020. November 2019. [https://www.nccn.org/professionals/physician_gls/default.aspx] (Accessed: June 2020).CRT, chemoradiotherapy; HRQoL, health-related quality of life; SCCA, squamous cell carcinoma of the anus; SOC, standard of care.

Immunotherapy may improve outcomes in anal cancer

1.

Naidoo J, et al. Br J Cancer 2014;111(12):2214

9; 2. Bian JJ, et al. Transl Gastroenterol Hepatol 2019;4:57; 3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Anal Carcinoma, version 1.2020. November 2019. [https://www.nccn.org/professionals/physician_gls/default.aspx] (Accessed: June 2020).ICI, immune checkpoint inhibitor; NCCN, National Comprehensive Cancer 

Network; PD-1

, programmed cell death protein 1; SCCA, squamous cell carcinoma of the anus; TME,

tumor

microenvironment.

Summary

Anal cancer is

usually diagnosed

by taking a biopsy, and staging is then performed to guide the choice of treatment and predict the prognosis1Chemoradiation therapy is the mainstay of first-line treatment for locoregional disease and de novo metastatic disease, although some small lesions can be surgically excised2Unmet needs with chemoradiation, including the effects of treatment toxicity, the issue of locoregional treatment failure and the lack of an SOC for chemotherapy-resistant, unresectable, metastatic SCCA, has driven interest in alternative treatments

including immunotherapy

2,3

Two

checkpoint inhibitors are

recommended by NCCN

for second-line treatment of metastatic SCCA after CRT or chemotherapy

2

The use of

immunotherapies, including novel combinations,

in anal cancer is

being

actively

explored in clinical trials

4

1. Glynne-Jones R, et al. Radiother Oncol 2014;111(3):330



9; 2. National Comprehensive 

Cancer

 Network. NCCN Clinical Practice Guidelines in Oncology. Anal Carcinoma, version 1.2020. November 2019. [https://www.nccn.org/professionals/physician_gls/default.aspx] (Accessed:

June

2020);

3

. Sodergren SC, et al. Clin Oncol (R Coll Radiol) 2019;31(2):69



71; 4

.

Bian JJ, et al. Transl Gastroenterol Hepatol 2019;4:57.

CRT; chemoradiotherapy; SCCA

, squamous cell carcinoma of the

anus; SOC, standard of care;

NCCN

,

National Comprehensive Cancer 

Network.