I LINEA
Indicata CT di combinazione (schemi in ordine di preferenza):
- CBDCA + TXL (s. 5)
- FOLFCIS (CDDP+5-FU modificato) (s. 4)
- CISPLATINO + 5-FU (s. 3)
- DCF modificato (off-label)
(Pazienti fit (ECOG PS 0-1), di età < 70 anni), con malattia sintomatica) (s. 6)
In caso di tumore primitivo bulky sintomatico:
- Possibile valutare CT-RT palliativa in pazienti non precedentemente trattati per il tumore primitivo.
LINEE SUCCESSIVE
PRIMA SCELTA:
- Reintroduzione dello schema di I linea se PD dopo una pausa terapeutica di almeno 6 mesi
SECONDA SCELTA:
- Fluoropirimidina in monoterapia (Cape o 5-FU) (s. 8-9), se prima linea a base di CBDCA+Taxolo
- Taxolo (s.10), se prima linea a base di Fluoropirimidina + CDDP
- Nivolumab (L. 648) / Pembrolizumab (off label), soprattutto se CPS > 1
- Irinotecano/FOLFOX/Doxorubicina (dalla III linea - off label)
Riferimenti bibliografici principali:
- LG AIOM 2024 Neoplasie del Retto e Ano
- ESMO Guidelines 2021 Anal Cancer
- NCCN Guidelines 2025 Anal Cancer
- Rao S, Sclafani F, Eng C, et al. International Rare Cancers Initiative multicenter randomized phase II trial of cisplatin and fluorouracil versus carboplatin and paclitaxel in advanced anal cancer: InterAAct. J Clin Oncol. 2020;38(22):2510-2518.
- Kim R, Byer J, Fulp WJ, Mahipal A, Dinwoodie W, Shibata D. Carboplatin and paclitaxel treatment is effective in advanced anal cancer. Oncology. 2014;87(2):125-32
- Mondaca S, Chatila WK, Bates D, Hechtman JF, Cercek A, Segal NH, Stadler ZK, Varghese AM, Kundra R, Capanu M, Shia J, Schultz N, Saltz L, Yaeger R. FOLFCIS Treatment and Genomic Correlates of Response in Advanced Anal Squamous Cell Cancer. Clin Colorectal Cancer. 2019 Mar;18(1):e39-e52
- Kim S, François E, André T, Samalin E, Jary M, El Hajbi F, Baba-Hamed N, Pernot S, Kaminsky MC, Bouché O, Desrame J, Zoubir M, Ghiringhelli F, Parzy A, De La Fouchardiere C, Smith D, Deberne M, Spehner L, Badet N, Adotevi O, Anota A, Meurisse A, Vernerey D, Taieb J, Vendrely V, Buecher B, Borg C. Docetaxel, cisplatin, and fluorouracil chemotherapy for metastatic or unresectable locally recurrent anal squamous cell carcinoma (Epitopes-HPV02): a multicentre, single-arm, phase 2 study. Lancet Oncol. 2018 Aug;19(8):1094-1106.
- Ducreux M, Kim S, Borg C. Selecting the right chemotherapy in first-line advanced squamous cell carcinoma of the anus. Ann Oncol. 2021 Nov 26:S0923-7534(21)04832-8
- Rao S, Samalin-Scalzi E, Evesque L, Ben Abdelghani M, Morano F, Roy A, Dahan L, Tamberi S, Dhadda AS, Saunders MP, Casanova N, Guimbaud R, Lievre A, Maurel J, Fakih M, Tian C, Harrison J, Jones MM, Cornfeld M, Spano JP, Rochefort P; POD1UM-303/InterAACT-2 study investigators. Retifanlimab with carboplatin and paclitaxel for locally recurrent or metastatic squamous cell carcinoma of the anal canal (POD1UM-303/InterAACT-2): a global, phase 3 randomised controlled trial. Lancet. 2025 Jun 14;405(10495):2144-2152. doi: 10.1016/S0140-6736(25)00631-2. PMID: 40517007.