Management of Two Cases of Recurrent Anal Carcinoma
A 64-year-old female presented to our center at the time of her third recurrence with a 6-year prior history of anal carcinoma. At this time, her ECOG score was 1. Her primary tumor had initially been treated with concurrent chemoradiation, mitomycin C and 5-fluorouracil (5-FU) and staged as T3NXMX. Notably, the tumor was negative for HPV. Recurrence in the right groin was noted 10 months later and managed with 7 months of cisplatin plus paclitaxel chemotherapy. She remained free of disease for approximately the next 5 years, but subsequently experienced a second recurrence in the right groin (pathology confirming poorly differentiated squamous cell carcinoma). Surgical resection was performed, with the patient experiencing a complication of deep venous thrombosis.\nUnfortunately, PET-CT scan demonstrated evidence of another recurrence. Further surgery and radiation were not believed to be good options at this time, and after extensive discussions the patient was treated with the combination of irinotecan plus cetuximab. Although she experienced morbidity (diarrhea, bone marrow suppression) of the treatment and advanced disease process (cellulitis, constipation), she remained without evidence of progression of the cancer for 14 months following the initiation of irinotecan plus cetuximab.\nAt this point, the patient was treated with additional local radiation, maintaining a stable clinical state for approximately 11 months.\nPemetrexed was subsequently initiated, based on a molecular profiling study which revealed that the tumor exhibited low expression of thymidylate synthetase. The patient continued on this agent with stable disease for 9 months until evidence of disease progression was demonstrated.