What is New in Anal Cancer in the Last 12 Months?

Cathy Eng, MD, FACP, FASCO, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, discusses the latest developments in anal cancer over the past 12 months at the 2019 World Congress on Gastrointestinal Cancer.

Transcript

I was asked to give an update about my lecture here at the World GI Congress in Barcelona. I decided to focus specifically on the role of immune checkpoint inhibitors, which has been a new development in the refractory setting for metastatic anal carcinoma.

I really want to emphasize the fact that anal cancer actually has been rising in incidents up until this past year in the United States. Specifically, it's expected to impact approximately 35,000 individuals globally.

This is an unmet need in regard to identifying patients that may benefit from novel approaches for high-risk, locally advanced disease as well as the metastatic setting. I want to emphasize that, at last year's ESMO, the results of InterAACT EA2133 looked at the role of carboplatin and taxol, weekly paclitaxel, versus 5FU[fluorouracil]/cisplatin in the treatment-naive metastatic setting.

Basically, they identified that the best regimen despite a polar response rate of 57 and 59 percent was actually much better for the carboplatin/weekly paclitaxel in regard to reduced toxicities. This also resulted in a statistically improvement in overall survival. That will actually serve as our new chemotherapy backbone for the treatment-naive setting for metastatic anal carcinoma patients.

In regard to immune checkpoint inhibition, there has been some very promising data in regard to nivolumab as well as pembrolizumab, which have now received new NCCN treatment guidelines indications. But there are currently other ongoing trials as well, looking at the benefits of adding these drugs.

Currently, NCI9673 is a randomized phase 2 study of nivolumab and plus or minus IP[ipilimumab]. EA2165 is for high-risk, early-stage, locally advanced disease. Following chemoradiation therapy, patients are randomized to standard observation versus immune checkpoint inhibition for six months.

There are also other trials internationally as well. There's a trial in France looking at DCF, a plus or minus immune checkpoint inhibitor that is also ongoing. As well as there's going to be a replacement trial for the InterAACT trial that will be ongoing in the United States. That is currently being finalized.

So there's a lot of new developments in the development of treatment for anal carcinoma as well as reducing toxicities. There's a very nice trial that's going to be opened shortly looking at reducing the dose of radiation to reduce toxicities and that's the DECREASE trial. That's being led by Jennifer Dorth over at Case Western.

A lot of exciting new developments.