Combined therapy reduces death from anal cancer by a third

New data presented at the National Cancer Research Institute (NCRI) Cancer Conference has shown anal cancer patients who received combined chemo and radiotherapy rather than just radiotherapy were a third less likely to die in the long term from anal cancer.

Researchers from the Cancer Research UK and UCL (University College London) cancer trials centre undertook a six -year trial of 577 patients with anal cancer – who were then monitored for an average of 13 years.

Around half the patients on the trial received the standard treatment for anal cancer, radiotherapy alone - while the other half received a new form of treatment which combined chemotherapy and radiotherapy treatment (CRT).

Twelve years after the trial had finished 34 per cent of patients treated with chemo-radiation suffered a relapse of the anal cancer compared with 59 per cent of the group who received radiotherapy alone (a difference of 25 per cent).

This long term follow-up data confirms the earlier trial results published in 1996 and overall they now show a 33 per cent reduction in anal cancer deaths and a 54 per cent reduction in cases of the cancer returning to the same area, in the group which received CRT.

Overall, the trial results confirm that CRT should be the standard treatment for patients with anal cancer worldwide.

There are around 850 cases of anal cancer diagnosed in the UK each year. In 2006, there were 239 deaths from the disease in UK. Most patients have evidence of HPV infection in the anal area - the same HPV 16 and 18 strains which cause cervical cancer.

People who have receptive anal intercourse are more at risk and slightly more women than men are affected.

Professor Jonathan Ledermann, director of Cancer Research UK and UCL cancer trials centre, said: “The trial found that combined chemo-radiation therapy provides clear and sustained benefit for anal cancer patients. The long-term follow up of this trial confirms the magnitude of the benefit seen in the first years after therapy is still maintained for more than a decade.”

Of the 577 trial participants, 285 received radiotherapy alone over four to five weeks. Separately 292 patients received the same therapy combined with chemotherapy. Chemotherapy comprised administration of 5-fluorouracil, during the first and last weeks of radiotherapy, as well as a single dose of mitomycin C on day one of the therapy.

Professor Roger James, clinical director of the Kent and Medway Cancer Network, presenting the trial results at the NCRI conference, said: “This trial outcome is an enormously positive result and a benchmark by which to set improvement in care and therapy for cancer patients.”

Kate Law, Cancer Research UK’s director of clinical trials, said: “The results from this trial are striking and have improved the way this cancer is treated across the globe to greatly reduce deaths from anal cancer.

“There are ongoing Cancer Research UK-funded trials investigating different ways to administer chemotherapy to further improve patient treatment and care. We are also keen to raise awareness of this disease to high risk groups which include gay and bisexual men so they are aware of the causes and take action if they have symptoms. Early detection is crucial for a successful outcome.”