Treatment of Anal Squamous Cell Carcinoma with Extrapelvic Metastatic Disease
This protocol addresses systemic management in patients with anal squamous cell carcinoma whose disease has spread beyond the pelvis to distant sites.
Clinical scenario
Extrapelvic metastatic disease represents a distinct and more advanced stage of anal squamous cell carcinoma. Systemic therapy is generally recommended in this setting, and the choice of regimen depends on the patient's prior treatment history.
Treatment approach (partial overview)
The protocol addresses the role of immunotherapy agents in this setting. An important consideration governs whether certain chemotherapy backbones are appropriate based on what was used previously.
Full regimen details, sequencing, and eligibility criteria are available in the complete protocol below.
References
DOI: 10.6004/jnccn.2023.0030
Systemic therapy is generally recommended for extrapelvic metastatic disease.
Although further studies of PD-1/PD-L1 inhibitors are warranted, the panel added nivolumab and pembrolizumab as preferred options for patients with metastatic anal cancer who have experienced progression on first-line chemotherapy in the 2018 version of these guidelines.
The panel also notes that platinum-based chemotherapy should not be given in second line if disease progressed on platinum-based therapy in first line.