The methods for treating anal cancer are listed here, along with information on salvage therapy, restricted localised disease, metastatic disease, and other unique issues.

Limited localized disease

Current primary recommendations for non-metastatic anal cancer include concurrent chemotherapy and radiation therapy (Stage I–III; any T, any N, M0). Mitomycin and 5-fluorouracil (5-FU) are two common medications; 5-FU can be replaced with capecitabine. Given inconsistent clinical trial findings, there is some debate about whether cisplatin should be used instead of mitomycin in limited-stage cancer. The National Comprehensive Cancer Network (NCCN) recommends 5FU plus cisplatin and radiation therapy as a category 2B treatment.

Mitomycin + 5-FU + radiotherapy

• Continuous IV infusion of 5-FU at a dose of 1000 mg/m2/day on days 1-4 and 29-32 (the daily maximum dose of 5-FU is 2000 mg) together with a 10 mg/m 2 IV bolus of mitomycin on days 1 and 29 (maximum 20 mg per dose)
• Radiotherapy (RT) should be administered at all disease stages; a minimum of 45 Gy should be administered over 5 weeks.
• Patients with T3, T4, or node-positive illness or those who have residual disease after receiving an initial 45 Gy may be considered for further RT of 9-14 Gy.
• Cisplatin can be used in place of 5-FU; it offers comparable rates of complete remission (CR) and colostomy.

Mitomycin + capecitabine + RT

• Mitomycin 10 mg/m 2 days 1 and 29 along with concurrent RT; Capecitabine 825 mg/m 2 PO BID, Monday through Friday, on each day that RT is administered, for the length of RT (usually 28 treatment days).
• Mitomycin 12 mg/m 2 IV bolus day 1 along with concurrent RT and capecitabine 825 mg/m 2 PO BID days 1–5 weekly for six weeks

Metastatic disease

Stage IV (any T, any N, M1): Platinum-based chemotherapy is frequently used to treat metastatic illness. Regimens might contain 5-FU or other substances.

5-FU(FOLFCIS) with cisplatin

• 5-FU 1000 mg/m2/d IV continuous infusion on days 1-4 with Cisplatin 60 mg/m2 day 1; repeat every 3 weeks.
• 5-FU 750 mg/m2/d IV continuous infusion on days 1-4, along with cisplatin 75 mg/m2 on day 1; repeat every 4 weeks.
• Oxaliplatin 85 mg/m2 IV on day 1, Leucovorin 400 mg/m2 IV on day 1, 5-FU 400 mg/m2 IV bolus on day 1, then 1200 mg/m2/d x 2 days (total 2400 mg/m2 over 46-48 hours) are the dosages for mFOLFOX. IV infusion that is ongoing.
• Recur every two weeks.

Carboplatin and paclitaxel

• Area under the curve for carboplatin (AUC) 5 (see Carboplatin AUC Dose Calculation [Calvert formula]) Repeat every 21 days with IV day 1 + Paclitaxel 175 mg/m 2 IV day 1.
• Following the failure of more conventional treatments, patients may receive the following types of therapy:
• Pembrolizumab 200 IV q3wk or 400 mg IV q6wk until disease progression or intolerable toxicity, or up to 24 months in patients without disease progression.

Salvage treatment

• After chemoradiotherapy, salvage therapy may be required for recurrent or persistent illness.
• Local recurrences can sometimes be effectively treated surgically, although locally recurring anal squamous cell carcinoma is more problematic and has a higher mortality rate.
• In a 1999 analysis of 185 patients who received radiotherapy or chemoradiotherapy between 1976 and 1996, a total of 42 patients went on to develop local failure. Of these patients, 26 underwent salvage therapy that included abdominoperineal resection, and of these patients, 43% had long-term 5-y survival and control of their disease.

The Journal of Carcinogenesis & Mutagenesis is a peer-reviewed medical journal in cancer biology. This Scientific Journal focuses on the recognition of cellular responses to DNA damage, apoptosis (cell death), and inactivation of tumor suppressor genes and analysis of the carcinogenic process by genetic and epigenetic alterations in genes for the study of cancer initiation and progression.

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