Anal cancer: current and future treatment strategies

Anal cancer is a relatively rare malignancy, accounting for approximately 2% of gastrointestinal cancers. Concurrent chemoradiation with 5-fluorouracil/mitomycin remains the standard of care for the treatment of anal cancer. There is currently no proven role for platinum-based induction or adjuvant chemotherapy in anal cancer, even in cases of bulky disease. Multiple trials have shown that radiosensitization with concurrent chemotherapy is beneficial over radiation alone, and in particular, efforts to remove or substitute mitomycin from the chemoradiation regimen have been unsuccessful. Because local-regional control remains a challenge in the management of anal cancer, future studies will need to focus on radiation dose-escalation and/or addition of further chemotherapy or targeted agents. Patient selection, eg, with PET-CT or with biomarkers including HPV status, may be necessary to define patients who need more aggressive local treatment, ie, for patients with bulky disease, or to de-escalate