From the Guidelines
FOLFOX is a recommended treatment option for metastatic anal cancer, with the panel suggesting strong consideration of discontinuation of oxaliplatin after 3-4 months due to potential neurotoxicity 1. The efficacy of FOLFOX in treating metastatic anal cancer is supported by its inclusion as a recommended treatment option in the NCCN clinical practice guidelines in oncology, despite limited data in this specific setting 1.
Key Points
- FOLFOX is a combination of 5-fluorouracil, leucovorin, and oxaliplatin, which works by disrupting DNA synthesis and repair through multiple mechanisms.
- The standard FOLFOX regimen is typically continued until disease progression or unacceptable toxicity, with most patients receiving 6-12 cycles.
- Common side effects of FOLFOX include neuropathy (from oxaliplatin), diarrhea, neutropenia, and fatigue.
- Patients should be monitored with regular blood tests, clinical assessments for neuropathy, and imaging every 2-3 months to assess treatment response.
Treatment Considerations
- The panel recommends strong consideration of discontinuation of oxaliplatin after 3-4 months (or sooner for unacceptable neurotoxicity) while maintaining other agents until time of disease progression 1.
- Oxaliplatin may be reintroduced if it was discontinued for neurotoxicity rather than for disease progression.
- Other recommended treatment options for metastatic anal cancer include 5-FU, leucovorin, and cisplatin (FOLFCIS); 5-FU, leucovorin, and cisplatin (category 2B); or modified docetaxel, cisplatin, and 5-FU (DCF, category 2B) 1.
Ongoing Research
- Several ongoing clinical trials are investigating the role of checkpoint inhibitors in the first-line treatment of metastatic anal cancer, including the InterAACT2 trial comparing chemotherapy alone to chemotherapy plus nivolumab 1.
From the Research
Efficacy of FOLFOX in Treating Metastatic Anal Cancer
- The provided studies do not directly address the efficacy of FOLFOX in treating metastatic anal cancer. However, study 2 examines the safety and efficacy of a modified schedule, FOLFCIS (leucovorin, fluorouracil, and cisplatin), which is essentially a FOLFOX schedule with cisplatin substituted for oxaliplatin, in patients with advanced anal squamous cell cancer.
- In study 2, the response rate to FOLFCIS was 48% (95% confidence interval [CI], 32.6%-63%), with a median follow-up of 41.6 months, progression-free survival and overall survival were 7.1 months (95% CI, 4.4-8.6 months) and 22.1 months (95% CI, 16.9-28.1 months), respectively.
- Studies 3, 4, 5, and 6 discuss the efficacy of FOLFOX or similar regimens in treating metastatic colorectal cancer, but do not provide direct evidence for its use in metastatic anal cancer.
- The efficacy of FOLFOX in treating metastatic anal cancer cannot be directly determined from the provided studies, as they focus on other types of cancer, such as colorectal cancer 3, 4, 5, 6 or anal squamous cell cancer with a modified FOLFOX regimen 2.