Transcript The treatment of metastatic squamous cell carcinoma (SCCA

The treatment of metastatic squamous
cell carcinoma (SCCA) of the anal canal:
A single institution experience
P. Pathak, B. King, A. Ohinata, P. Das,
C.H. Crane, J.L. Chase, C. Eng
The University of Texas M. D. Anderson Cancer
Center, Houston, Texas
Objectives
To evaluate progression-free survival (PFS) following
first- line therapy in metastatic SCCA of the anal canal.
To evaluate overall survival (OS) from time of diagnosis
to death or point of last follow up in patients who
received first- line therapy.
Methods
Study Design and Population


Single institution, retrospective chart review.
Patients with histologically confirmed stage IV
squamous cell carcinoma of the anal canal (SCCA)
between January 2000 to January 2007.
Inclusion Criteria

Stage IV SCCA of the anal canal who have received
first- line therapy based on pathology, radiology
reports and have had follow up at M.D. Anderson
Cancer Center.
Exclusion Criteria


Patients with anal cancer of any other histology other
than squamous cell type.
Patients with prior or concurrent malignancies within
the past 5 years excluding superficial skin cancers.
Data Collection
Patients were identified from electronic
medical records.
Chart reviews were performed on all patients
by at least two investigators.
The information collected included:




Demographics.
Histology and sites of metastasis.
Therapy prior to development of metastasis.
First-line, second-line, and third-line treatment
regimens for metastatic disease
Table 1: Patient and Tumor Characteristics
Number of Patients
Patient Characteristics
Median age at diagnosis of metastasis
Females
Race:
Caucasians
African-Americans
Others
HIV+
Tumor Characteristics
Well differentiated histology
Moderately differentiated histology
Poorly differentiated histology
Liver Metastasis
Lung Metastasis
Bone Metastasis
Distant Lymph Node Metastasis
40
56 yrs
75%
85%
10%
5%
5%
3%
38%
43%
60%
45%
20%
55%
Table 2: Treatment Provided
Prior Treatment with Curative Intent:
Chemoradiation:
 5FU + Mitomycin C
 Cisplatin
 Other
Salvage surgery
73% (29/40)
55% (16/29)
38% (11/29)
7% (2/29)
17% (5/29)
First-line Therapy for Metastasis:
Systemic chemotherapy
Systemic chemotherapy + Chemoradiation
Systemic Chemotherapy + Biologic Therapy
Systemic chemotherapy + Metastatectomy
Palliative Chemoradiation
Other
55% (22/40)
8% (3/40)
3% (1/40)
10% (4/40)
12% (5/40)
12% (5/40)
Second-line Therapy :
Systemic Chemotherapy
Biologic Therapy
Surgery
65% (26/40)
73% (19/26)
15% (4/26)
27% (7/26)
> 3 Lines of Chemotherapy
43% (16/40)
Median Follow-up
18 months
Table 3: First-line Chemotherapy
Type
5-FU/capecitabine + Platinum
Irinotecan (CPT-11) + Platinum
Taxanes + Platinum
Patients N=30 (%)
70% (21/30)
10% (3/30)
20% (6/30)
0.2
0.4
0.6
0.8
1.0
Figure 1: Kaplan-Meier for Progression- Free Survival (N= 37*)
0.0
N Deaths/N=29/37
Median OS (95% CI): 7.2 (4.83, 21.3)
0
10
20
* 3 patients are currently receiving
chemotherapy
30
Time (months)
40
50
60
0.6
0.4
0.2
N deaths/N=20/40
Median OS (95% CI): 38 (15- 61)
0.0
Overall Survival Probability
0.8
1.0
Figure 2: Kaplan-Meier for Overall Survival
0
10
20
30
Time (months)
40
50
60
Results
There were a total of 53 patients who fulfilled the
inclusion criteria; 40 patients were considered evaluable;
6 were lost to follow-up; and 7 were not treated due to
poor performance status.
A total of 30 out of 40 patients were eligible for response
to first-line systemic chemotherapy.
The median number of therapies provided = 2.
The response rate to first-line systemic chemotherapy
was 33%.
Conclusions
Despite the success of chemoradiation therapy for local
disease, an established regimen for the treatment of
stage IV patients with squamous cell carcinoma of the
anal canal has not been identified.
Systemic chemotherapy regimens utilized in more
commonly diagnosed squamous cell carcinomas are
efficacious in this setting.
Consideration of surgery and/or radiation therapy with
curative intent for focal metastatic disease is reasonable
with multidisciplinary management.
Prospective randomized trials of both systemic and
biologic therapy in this select group of patients would
provide further insight for effective management of this
patient population.
References
1. Clark MA, Hartley A, Geh JI. Cancer of the
anal canal. Lancet Oncol 2004; 5 (3): 149-57.
2. Maggard MA, Beanes, SR, Ko CY. Anal canal
cancer: a population-based reappraisal. Dis
Colon Rectum 2003; 46 (11): 1517-24.