Advanced anal cancer: carboplatin-paclitaxel combo is new standard of care

  • Rao S & al.
  • J Clin Oncol
  • 12 Jun 2020

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • In a head-to-head trial, carboplatin plus paclitaxel yielded responses similar to cisplatin plus 5-fluorouracil in patients with advanced anal cancer, with significantly fewer serious adverse events.

Why this matters

  • Carboplatin plus paclitaxel should now be considered the standard of care in the frontline setting.

Study design

  • Phase 2 randomized InterAACT trial.
  • 91 chemotherapy-naive patients with advanced anal cancer were randomly assigned to cisplatin plus 5-fluorouracil or carboplatin plus paclitaxel.
  • Primary endpoint was objective response rate (ORR).
  • Funding: Cancer Research UK; others.

Key results

  • The median follow-up for all patients was 28.6 months.
  • With cisplatin+5-fluorouracil:
    • ORR: 57%.
      • Complete response: 17%.
      • Partial response: 40%. 
  • With carboplatin+paclitaxel:
    • ORR: 59%.
      • Complete response: 12.8%.
      • Partial response: 46.2%.
  • The rate of serious adverse events was significantly higher with cisplatin+5-fluorouracil vs carboplatin-paclitaxel (62% vs 36%; P=.016).
  • No significant difference was observed between the cisplatin+5-fluorouracil and carboplatin-paclitaxel groups in:
    • Median PFS: 5.7 vs 8.1 months.
      • Adjusted HR (aHR): 1.17 (P=.564).
    • Median OS: 12.3 vs 20 months.
      • aHR: 1.78 (P=.059).

Limitations

  • Limited QoL assessment because of low adherence.