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dc.contributor.authorSclafani, Fen_US
dc.contributor.authorMorano, Fen_US
dc.contributor.authorCunningham, Den_US
dc.contributor.authorBaratelli, Cen_US
dc.contributor.authorKalaitzaki, Een_US
dc.contributor.authorWatkins, Den_US
dc.contributor.authorStarling, Nen_US
dc.contributor.authorChau, Ien_US
dc.contributor.authorRao, Sen_US
dc.date.accessioned2017-08-18T09:07:44Z
dc.date.issued2017-04en_US
dc.identifier.citationThe oncologist, 2017, 22 (4), pp. 402 - 408en_US
dc.identifier.issn1083-7159en_US
dc.identifier.urihttps://repository.icr.ac.uk/handle/internal/786
dc.identifier.eissn1549-490Xen_US
dc.identifier.doi10.1634/theoncologist.2016-0241en_US
dc.description.abstractAlthough treatment of localized anal cancer (AC) is well established, very little evidence is available to inform the management of advanced tumors, and the prognosis of these patients remains poor. We have analyzed treatment pathways and outcomes of a single-institution series of advanced AC patients in order to provide insight into the management of this rare condition.Inclusion criteria included epidermoid histology, inoperable locally recurrent or metastatic disease, and availability of full medical records. The primary objective was overall survival (OS). Prognostic factors were analyzed in univariate models.Sixty-four patients (1997-2014) were included: 16 (25.0%) with inoperable locally advanced and 48 (75.0%) with metastatic tumors. Fifty-one (79.7%) received at least one line of chemotherapy; of these, 37% underwent multimodality treatment. A combination of a platinum agent plus a fluoropyrimidine was the most common first-line regimen (74.5%), with an objective response rate (ORR) of 34.4% (95% confidence interval [CI], 18.6%-53.2%). Paclitaxel-based chemotherapy was used in 15 patients as front-line or salvage treatment, and the overall ORR was 53.3% (95% CI, 26.6%-78.7%). Median progression-free survival (PFS) after first- and second-line chemotherapy was 5.8 (interquartile range [IQR], 2.8-7.6) and 3.2 (IQR, 2.5-7.1) months, respectively. Five-year OS in the overall population was 15% (95% CI, 7.0%-25.0%). Age ≤65 years and liver metastases were predictive of better PFS (hazard ratio [HR], 0.39; 95% CI, 0.16-0.97; p = .04) and worse OS (HR, 2.25; 95% CI, 1.25-4.03; p = .01), respectively.A platinum agent plus a fluoropyrimidine and paclitaxel-based chemotherapy are active regimens for advanced AC. Clinical trials are needed to standardize treatment pathways, investigate the potential of novel therapeutics, and improve the poor prognosis of this rare condition. The Oncologist 2017;22:402-408Implications for Practice: Because of the lack of randomized trials, the optimal management of advanced anal cancer is uncertain. Despite its retrospective analysis and relatively small sample size, this is the second largest study ever conducted in this setting, and, as such, it has the potential to serve as a valuable source of information for everyday clinical practice. These findings suggest that chemotherapy with a platinum agent plus a fluoropyrimidine or paclitaxel-containing regimens are reasonable treatment options for patients with inoperable locally recurrent or metastatic anal carcinoma.en_US
dc.formatPrint-Electronicen_US
dc.format.extent402 - 408en_US
dc.languageengen_US
dc.language.isoengen_US
dc.rights.urihttp://www.rioxx.net/licenses/all-rights-reserveden_US
dc.subjectHumansen_US
dc.subjectAnus Neoplasmsen_US
dc.subjectPlatinumen_US
dc.subjectPaclitaxelen_US
dc.subjectPyrimidinesen_US
dc.subjectNeoplasm Stagingen_US
dc.subjectPrognosisen_US
dc.subjectDisease-Free Survivalen_US
dc.subjectCombined Modality Therapyen_US
dc.subjectAdulten_US
dc.subjectAgeden_US
dc.subjectMiddle Ageden_US
dc.subjectFemaleen_US
dc.subjectMaleen_US
dc.titlePlatinum-Fluoropyrimidine and Paclitaxel-Based Chemotherapy in the Treatment of Advanced Anal Cancer Patients.en_US
dc.typeJournal Article
dcterms.dateAccepted2016-09-27en_US
rioxxterms.versionofrecord10.1634/theoncologist.2016-0241en_US
rioxxterms.licenseref.startdate2017-04en_US
rioxxterms.typeJournal Article/Reviewen_US
dc.relation.isPartOfThe oncologisten_US
pubs.issue4en_US
pubs.notes12 monthsen_US
pubs.organisational-group/ICR
pubs.organisational-group/ICR/Primary Group
pubs.organisational-group/ICR/Primary Group/ICR Divisions
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Gastrointestinal Cancers Clinical Trials
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Gastrointestinal Cancers Clinical Trials/Gastrointestinal Cancers Clinical Trials (hon.)
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)
pubs.organisational-group/ICR/Primary Group/ICR Divisions/Clinical Studies/Medicine (RMH Smith Cunningham)/Medicine (RMH Smith Cunningham) (hon.)
pubs.organisational-group/ICR/Primary Group/Royal Marsden Clinical Units
pubs.publication-statusPublisheden_US
pubs.volume22en_US
pubs.embargo.terms12 monthsen_US
icr.researchteamGastrointestinal Cancers Clinical Trialsen_US
icr.researchteamMedicine (RMH Smith Cunningham)en_US
dc.contributor.icrauthorStarling, Naureenen_US
dc.contributor.icrauthorCunningham, Daviden_US
dc.contributor.icrauthorChau, Ianen_US
dc.contributor.icrauthorMarsden,en_US


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