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Efficacy and tolerance of cetuximab in combination with 5 FU plus irinotecan based chemotherapy in metastatic squamous cell anal carcinoma

Published:September 08, 2022DOI:https://doi.org/10.1016/j.dld.2022.08.026

      Abstract

      Background

      Squamous cell anal carcinoma (SCAC) is an uncommon neoplasia often cured by surgery and/or chemo-adiation therapy at the localized stage. Although the first-line treatment for metastatic anal canal cancer is now better codified with two validated treatment regimens, carboplatin-paclitaxel and modified docetaxel-cisplatin-5FU (DCF), there is little data and no consensus regarding subsequent lines [
      • Rao S.
      • Sclafani F.
      • Eng C.
      • Adams R.A.
      • Guren M.G.
      • Sebag-Montefiore D.
      • et al.
      International Rare Cancers Initiative Multicenter Randomized Phase II Trial of Cisplatin and Fluorouracil Versus Carboplatin and Paclitaxel in Advanced Anal Cancer: interAAct.
      ,
      • Rao S.
      • Guren M.G.
      • Khan K.
      • Brown G.
      • Renehan A.G.
      • Steigen S.E.
      • et al.
      Anal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.
      ,
      • Ducreux M.
      • Kim S.
      • Borg C.
      Selecting the right chemotherapy in first-line advanced squamous cell carcinoma of the anus.
      ,
      • Kim S.
      • François E.
      • André T.
      • Samalin E.
      • Jary M.
      • El Hajbi F.
      • et al.
      Docetaxel, cisplatin, and fluorouracil chemotherapy for metastatic or unresectable locally recurrent anal squamous cell carcinoma (Epitopes-HPV02): a multicentre, single-arm, phase 2 study.
      ,
      • Moureau-Zabotto L.
      • Vendrely V.
      • Abramowitz L.
      • Borg C.
      • Francois E.
      • Goere D.
      • et al.
      Anal cancer: french Intergroup Clinical Practice Guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SNFCP).
      ]. In this study, we report the safety and efficacy of cetuximab (an epidermal growth factor receptor inhibitor) in combination with 5-FU plus irinotecan based chemotherapy.

      Method

      A retrospective analysis of patients with metastatic SCAC (mSCAC), who failed on at least one prior line of treatment, before being treated with the combination FOLFIRI and cetuximab between March 2015 and February 2022 at Gustave Roussy cancer center, was performed.

      Results

      A total of 33 patients with a pre-treated mSCAC were analyzed. The combination of FOLFIRI and cetuximab provided a disease control rate (DCR) of 73%, and response rate of 30%. With a median follow-up of 38 months, the median progression free survival was 5.5 months, and the median overall survival was 13.7 months.
      Fourteen patients (42%) experienced grade III/IV adverse events that remained manageable.

      Conclusion

      Our study suggests that FOLFIRI and cetuximab is a promising combination in the management of mSCAC with a very good DCR and a manageable toxicity profile. Further prospective trials would be needed to confirm our results.

      Keywords

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