Carboplatin and Paclitaxel Chemoradiation for Localized Anal Cancer in Patients Not Eligible for Mitomycin and 5-Fluorouracil

Alyssa K DeZeeuw; Michael F Bassetti; Evie H Carchman; Charles P Heise; Dana Hayden; Elise H Lawson; Cristina B Sanger; Ray King; Noelle K LoConte; Sam J Lubner; Jeremy D Kratz; Dustin A Deming

doi:10.3390/cancers16173062

Carboplatin and Paclitaxel Chemoradiation for Localized Anal Cancer in Patients Not Eligible for Mitomycin and 5-Fluorouracil

Cancers (Basel). 2024 Sep 3;16(17):3062. doi: 10.3390/cancers16173062.

Authors

Alyssa K DeZeeuw¹, Michael F Bassetti^{2

3}, Evie H Carchman^{2

4

5}, Charles P Heise^{2

4}, Dana Hayden^{2

4}, Elise H Lawson^{2

4}, Cristina B Sanger^{2

4

5}, Ray King^{2

4}, Noelle K LoConte^{1

2}, Sam J Lubner^{1

2}, Jeremy D Kratz^{1

2

5}, Dustin A Deming^{1

2

6}

Affiliations

¹ Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA.
² Carbone Cancer Center, University of Wisconsin, Madison, WI 53792, USA.
³ Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA.
⁴ Division of Colorectal Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA.
⁵ William S Middleton Memorial Veterans Hospital, Madison, WI 53705, USA.
⁶ McArdle Laboratory for Cancer Research, Department of Oncology, Madison, WI 53705, USA.

Abstract

Background: Although squamous cell carcinoma of the anus (SCCA) is a relatively uncommon malignancy in the United States, it continues to increase in incidence. Treatment for locoregional disease includes mitomycin and 5-fluorouracil with radiation. This combination is associated with significant toxicity, limiting its use in patients who are older or have certain comorbidities. Carboplatin and paclitaxel (C/P) is an accepted treatment regimen for metastatic SCCA. We aim to evaluate the efficacy and toxicity of weekly C/P given with radiation for patients unable to receive standard chemoradiation for SCCA.

Methods: From our cancer registry, adult patients who received weekly intravenous C/P concurrent with standard-dose radiation for localized SCCA were included in this study. Clinical response was determined based on the evidence of disease on imaging and/or anoscopy. Toxicities were graded according to the CTCAE v5.

Results: Ten patients were included; eight were female, and the median age was 75.5 years (54-87). Six had T2 disease, and four had T3 tumors. Four had node-positive disease. The majority (70%) of patients were dosed at standard C (AUC 2) and P (50 mg/m²), with a limited subset requiring dose reduction for baseline performance status. Patients completed a mean of 78.3% (40-100%) of the intended treatments. A total of 89% of the patients achieved a complete clinical response. With a median follow-up of 25.8 months (3.4-50.4 months), 67% of the patients are alive and without recurrence. Two patients have had local recurrence, and one patient had metastatic progression. The most common toxicities of any grade included leukopenia (100%), anemia (100%), radiation dermatitis (100%), diarrhea (100%), and fatigue (100%). Grade 3 or higher toxicities included neutropenic fever (20%), neutropenia (30%), and anemia (30%).

Conclusions: This study demonstrates promising tolerability and efficacy for weekly C/P chemoradiation for patients with anal cancer unable to receive mitomycin and 5-fluorouracil. This regimen merits further investigation in prospective clinical trials.

Keywords: anal cancer; carboplatin; paclitaxel; radiation; squamous cell carcinoma of the anus.

Grants and funding

This study was funded by NIH P30 CA014520 (Cancer Center Support Grant, University of Wisconsin Carbone Cancer Center), JD Fluno Colorectal Cancer Precision Medicine Program, and the ACI/Schwenn Family Professorship.