[Metastatic or unresectable recurrent anal canal cancer: Therapeutic approaches and emerging perspectives]

Anal canal squamous cell carcinoma (ASCC) is a rare tumor, predominantly caused by HPV16 infection, with a rising incidence, highlighting the importance of optimizing primary prevention, particularly through vaccination. While management of localized disease is well-established, treatment strategies for advanced stages remain less standardized. With the advent of immunotherapy and the immunogenicity associated with HPV, immune checkpoint inhibitors are emerging as a promising therapeutic option. Recent results from the PODIUM trial suggest that combining immunotherapy with chemotherapy may become a new first-line standard in metastatic disease. ASCC also exhibits a complex molecular landscape, with potentially actionable genetic alterations, emphasizing the need to include these patients in dedicated clinical trials. Finally, monitoring HPV circulating tumor DNA (ctDNA) could help optimize patient management, better guide therapy, and prevent progression to advanced stages.