Difference between revisions of "Anal cancer"
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=Chemotherapy & radiation therapy= | =Chemotherapy & radiation therapy= | ||
| − | ==Fluorouracil (5-FU), Mitomycin (Mutamycin) | + | ==Fluorouracil, Mitomycin, radiation therapy== |
| − | ===Regimen=== | + | ===Regimen #1, James, et al. 2013 (ACT II)=== |
| − | *[[Fluorouracil (5-FU)]] 1000 mg/m2/day IV continuous infusion on days 1 | + | *[[Fluorouracil (5-FU)]] 1000 mg/m2/day IV continuous infusion on days 1 to 4, 29 to 32 |
| − | *[[Mitomycin (Mutamycin)]] 10 mg/m2 (maximum | + | *[[Mitomycin (Mutamycin)]] 12 mg/m2 (maximum dose per cycle: 20 mg) IV bolus once on day 1 |
| − | *Concurrent radiation therapy; at a minimum: 1.8 Gy per day | + | *Concurrent radiation therapy in James, et al. 2013: 1.8 Gy per day x 28 fractions (total dose: 50.4 Gy), given over 5.5 weeks; see James, et al. 2013 for details |
| + | |||
| + | '''5.5-week course''' | ||
| + | |||
| + | ===Regimen #2, UKCCCR Anal Cancer Trial Working Party 1996 (ACT I) & Northover, et al. 2010 (ACT I)=== | ||
| + | ''Because there were a few different schedules used in UKCCCR Anal Cancer Trial Working Party 1996 and Northover, et al. 2010, there is some variability in potential schedules.'' | ||
| + | *[[Fluorouracil (5-FU)]] 1000 mg/m2/day IV continuous infusion over 4 days (total dose for the week's treatment: 4000 mg/m2) during the first and last weeks of radiation therapy, "started at least 2 hours before the first radiation fraction" | ||
| + | **Alternate dosing & schedule (per physician discretion): [[Fluorouracil (5-FU)]] 750 mg/m2/day IV continuous infusion over 5 days (total dose for the week's treatment: 3750 mg/m2) during the first and last weeks of radiation therapy | ||
| + | *[[Mitomycin (Mutamycin)]] 12 mg/m2 (maximum dose per cycle: 20 mg) IV bolus once on day 1 | ||
| + | *Concurrent radiation therapy: 1.8 or 2.25 Gy fractions x 20 or 25 fractions (total dose: 45 Gy), given over 4 to 5 weeks; see Northover, et al. 2010 for details, including information about boost radiation therapy | ||
| + | |||
| + | '''4 or 5-week course''' | ||
| + | |||
| + | ===Regimen #3, Ajani, et al. 2008 (RTOG 98-11)=== | ||
| + | *[[Fluorouracil (5-FU)]] 1000 mg/m2/day IV continuous infusion on days 1 to 4, 29 to 32 | ||
| + | *[[Mitomycin (Mutamycin)]] 10 mg/m2 (maximum dose per cycle: 20 mg) IV bolus once per day on days 1 & 29 | ||
| + | *Concurrent radiation therapy; at a minimum: 1.8 Gy per day x 25 fractions (total dose: 45 Gy), given over 5 weeks; see Ajani, et al. 2008 for additional details | ||
| + | |||
| + | '''5-week course''' | ||
| + | |||
| + | Supportive medications: | ||
| + | *"Patients received appropriate premedications and hydration." | ||
===References=== | ===References=== | ||
| − | # Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson AB 3rd, Thomas CR Jr, Mayer RJ, Haddock MG, Rich TA, Willett C. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA. 2008 Apr 23;299(16):1914-21. [http://jama.ama-assn.org/content/299/16/1914.full link to original article] '''contains protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/18430910 PubMed] | + | # UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. 1996 Oct 19;348(9034):1049-54. [http://www.sciencedirect.com/science/article/pii/S0140673696034095 link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/8874455 PubMed] |
| + | # Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson AB 3rd, Thomas CR Jr, Mayer RJ, Haddock MG, Rich TA, Willett C. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA. 2008 Apr 23;299(16):1914-21. [http://jama.ama-assn.org/content/299/16/1914.full link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/18430910 PubMed] | ||
| + | # Northover J, Glynne-Jones R, Sebag-Montefiore D, James R, Meadows H, Wan S, Jitlal M, Ledermann J. Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I). Br J Cancer. 2010 Mar 30;102(7):1123-8. doi: 10.1038/sj.bjc.6605605. Epub 2010 Mar 16. [http://www.nature.com/bjc/journal/v102/n7/full/6605605a.html link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/20354531 PubMed] | ||
| + | # James RD, Glynne-Jones R, Meadows HM, Cunningham D, Myint AS, Saunders MP, Maughan T, McDonald A, Essapen S, Leslie M, Falk S, Wilson C, Gollins S, Begum R, Ledermann J, Kadalayil L, Sebag-Montefiore D. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2×2 factorial trial. Lancet Oncol. 2013 May;14(6):516-24. doi: 10.1016/S1470-2045(13)70086-X. Epub 2013 Apr 9. [http://www.sciencedirect.com/science/article/pii/S147020451370086X link to original article] '''contains verified protocol''' [http://www.ncbi.nlm.nih.gov/pubmed/23578724 PubMed] | ||
=Chemotherapy= | =Chemotherapy= | ||
| − | ==Fluorouracil | + | ==Fluorouracil & Cisplatin== |
| − | ===Regimen=== | + | ===Regimen, Faivre, et al. 1999=== |
| − | *[[Fluorouracil (5-FU)]] 1000 mg/m2/day IV continuous infusion on days 1 | + | *[[Fluorouracil (5-FU)]] 1000 mg/m2/day IV continuous infusion on days 1 to 5 |
| − | *[[Cisplatin (Platinol)]] 100 mg/m2 IV on day 2 | + | *[[Cisplatin (Platinol)]] 100 mg/m2 IV once on day 2 |
'''28-day cycles''' | '''28-day cycles''' | ||
Revision as of 16:42, 12 June 2013
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Chemotherapy & radiation therapy
Fluorouracil, Mitomycin, radiation therapy
Regimen #1, James, et al. 2013 (ACT II)
- Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion on days 1 to 4, 29 to 32
- Mitomycin (Mutamycin) 12 mg/m2 (maximum dose per cycle: 20 mg) IV bolus once on day 1
- Concurrent radiation therapy in James, et al. 2013: 1.8 Gy per day x 28 fractions (total dose: 50.4 Gy), given over 5.5 weeks; see James, et al. 2013 for details
5.5-week course
Regimen #2, UKCCCR Anal Cancer Trial Working Party 1996 (ACT I) & Northover, et al. 2010 (ACT I)
Because there were a few different schedules used in UKCCCR Anal Cancer Trial Working Party 1996 and Northover, et al. 2010, there is some variability in potential schedules.
- Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion over 4 days (total dose for the week's treatment: 4000 mg/m2) during the first and last weeks of radiation therapy, "started at least 2 hours before the first radiation fraction"
- Alternate dosing & schedule (per physician discretion): Fluorouracil (5-FU) 750 mg/m2/day IV continuous infusion over 5 days (total dose for the week's treatment: 3750 mg/m2) during the first and last weeks of radiation therapy
- Mitomycin (Mutamycin) 12 mg/m2 (maximum dose per cycle: 20 mg) IV bolus once on day 1
- Concurrent radiation therapy: 1.8 or 2.25 Gy fractions x 20 or 25 fractions (total dose: 45 Gy), given over 4 to 5 weeks; see Northover, et al. 2010 for details, including information about boost radiation therapy
4 or 5-week course
Regimen #3, Ajani, et al. 2008 (RTOG 98-11)
- Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion on days 1 to 4, 29 to 32
- Mitomycin (Mutamycin) 10 mg/m2 (maximum dose per cycle: 20 mg) IV bolus once per day on days 1 & 29
- Concurrent radiation therapy; at a minimum: 1.8 Gy per day x 25 fractions (total dose: 45 Gy), given over 5 weeks; see Ajani, et al. 2008 for additional details
5-week course
Supportive medications:
- "Patients received appropriate premedications and hydration."
References
- UKCCCR Anal Cancer Trial Working Party. UK Co-ordinating Committee on Cancer Research. Lancet. Epidermoid anal cancer: results from the UKCCCR randomised trial of radiotherapy alone versus radiotherapy, 5-fluorouracil, and mitomycin. 1996 Oct 19;348(9034):1049-54. link to original article contains verified protocol PubMed
- Ajani JA, Winter KA, Gunderson LL, Pedersen J, Benson AB 3rd, Thomas CR Jr, Mayer RJ, Haddock MG, Rich TA, Willett C. Fluorouracil, mitomycin, and radiotherapy vs fluorouracil, cisplatin, and radiotherapy for carcinoma of the anal canal: a randomized controlled trial. JAMA. 2008 Apr 23;299(16):1914-21. link to original article contains verified protocol PubMed
- Northover J, Glynne-Jones R, Sebag-Montefiore D, James R, Meadows H, Wan S, Jitlal M, Ledermann J. Chemoradiation for the treatment of epidermoid anal cancer: 13-year follow-up of the first randomised UKCCCR Anal Cancer Trial (ACT I). Br J Cancer. 2010 Mar 30;102(7):1123-8. doi: 10.1038/sj.bjc.6605605. Epub 2010 Mar 16. link to original article contains verified protocol PubMed
- James RD, Glynne-Jones R, Meadows HM, Cunningham D, Myint AS, Saunders MP, Maughan T, McDonald A, Essapen S, Leslie M, Falk S, Wilson C, Gollins S, Begum R, Ledermann J, Kadalayil L, Sebag-Montefiore D. Mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for treatment of squamous-cell carcinoma of the anus (ACT II): a randomised, phase 3, open-label, 2×2 factorial trial. Lancet Oncol. 2013 May;14(6):516-24. doi: 10.1016/S1470-2045(13)70086-X. Epub 2013 Apr 9. link to original article contains verified protocol PubMed
Chemotherapy
Fluorouracil & Cisplatin
Regimen, Faivre, et al. 1999
- Fluorouracil (5-FU) 1000 mg/m2/day IV continuous infusion on days 1 to 5
- Cisplatin (Platinol) 100 mg/m2 IV once on day 2
28-day cycles
References
- Faivre C, Rougier P, Ducreux M, Mitry E, Lusinchi A, Lasser P, Elias D, Eschwege F. [5-fluorouracile and cisplatinum combination chemotherapy for metastatic squamous-cell anal cancer]. [Article in French] Bull Cancer. 1999 Oct;86(10):861-5. link to original article & English summary contains protocol PubMed