Clinical Scenario

This protocol applies to patients with Stage IV (advanced or metastatic) anal cancer who are fit and eligible for systemic treatment — including those with symptomatic metastatic or recurrent disease not amenable to surgery.

Patient Eligibility

Fit patients with symptomatic metastatic or recurrent anal cancer that cannot be managed surgically should be considered for systemic chemotherapy. Eligibility for this pathway requires adequate performance status to tolerate active treatment.

Treatment Approach (partial summary)

Systemic chemotherapy combination regimens form the basis of treatment in this setting; immunotherapy approaches may also be considered in specific clinical contexts. The complete agent selection, sequencing, and decision algorithm are available in the full protocol.

References

DOI: 10.1016/j.annonc.2021.06.015

Eligible for systemic treatment
Otherwise fit patients with symptomatic metastatic or recurrent disease not amenable to surgery should be considered for ChT.
Second-line: cisplatin–5-FU, carboplatin, doxorubicin, taxane, irinotecan ± cetuximab or combinations [III, B]
PD-L1 inhibitors may be considered where possible in patients who have progressed on first-line therapy in clinical trials [III, B].
Cisplatin in combination with 5-FU/capecitabine, carboplatin or docetaxel-based combinations are alternatives in patients with ChT-naive advanced anal cancer [III, B].

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Systemic Treatment for Stage IV Advanced/Metastatic Anal Cancer in Fit, Eligible Patients

References