New approaches in palliative systemic therapy of anal squamous cell carcinoma

Metastatic and locally recurrent inoperable anal squamous cell carcinoma (ASCC) belong to rare tumours - ASCC accounts for about 2% of gastrointestinal tumours. Synchronous metastatic involvement is usually confirmed in approximately 15% of patients and about 20 % of patients develop relapse in the form of distant metastases after curative treatment. The current standard palliative systemic treatment is a PF regimen composed of 5-fluorouracil (5-FU) with cisplatin (cDDP) or a combination of carboplatin with paclitaxel.

The aim of this study is to summarize other options for systemic palliative care in ASCC, including the results of relevant clinical trials performed with new or modified regimens. Triple combinations with taxanes have yielded promising treatment results, and in particular, the inclusion of the DCF regimen (cDDP + 5-FU + docetaxel) in first-line treatment results in a significant increase in treatment responses with good treatment tolerance. Another promising option for palliative care is immunotherapy with checkpoint inhibitors PD-1 or PD-L1, which can be successfully used in palliative systemic treatment or in curative regimens. Epidermal growth factor receptor inhibitors remain the subject of research, whose role in the primary or palliative treatment of ASCC is not entirely clear.

Compared to standard chemotherapy, available data confirm the treatment outcomes improvement in the use of triple combination DCF with docetaxel or immunotherapy with checkpoint inhibitors in the treatment of metastatic ASCC.