Treatment protocols for anal cancer

INTRODUCTION — The following material represents a subset of chemotherapy and immunotherapy regimens that are used for the treatment of patients with anal cancer, both for primary treatment of locoregional disease, and for treatment of advanced disease. This is not an exhaustive list; it includes regimens that are considered by the authors and editors to be commonly used and important for the care of patients with anal cancer. Additional regimens may be added over time, particularly as treatment for anal cancer evolves.

This topic review is intended to provide only a listing of chemotherapy and immunotherapy regimens. It does not address the appropriate context for use of these regimens in the care of patients with anal. Clinicians should refer to the individual disease-oriented topic review that discusses the use of these protocols in appropriate clinical situations. (See "Clinical features and staging of anal cancer".)

These tables are provided as examples of how to administer these regimens; there may be other acceptable methods. All chemotherapy and immunotherapy regimens must be administered by clinicians who are trained in the use of chemotherapy and immunotherapy. The clinician is expected to use his or her independent medical judgment in the context of individual circumstances to make adjustments, as necessary.

REGIMENS

Initial therapy for locoregional disease

Mitomycin plus fluorouracil and RT —  (table 1)

Mitomycin plus capecitabine and RT —  (table 2)

Cisplatin plus fluorouracil and RT —  (table 3)

Advanced disease

Cisplatin plus fluorouracil —  (table 4)

Docetaxel, cisplatin, and fluorouracil (DCF) —  (table 5)

Weekly paclitaxel plus every-three-week carboplatin —  (table 6)

Every-three-week paclitaxel and carboplatin —  (table 7)

Modified DCF —  (table 8)

Nivolumab monotherapy —  (table 9)

Pembrolizumab monotherapy —  (table 10)

ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Scott M Wirth, PharmD, BCOP, who contributed to an earlier version of this topic review.