A Pattern of Care Report on the Management of Patients with Squamous Cell Carcinoma of the Anus—A Study by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gastrointestinal Tumors Study Group

Background and objectives: The diagnosis and therapy of squamous cell carcinoma of the anus may vary significantly in daily clinical practice, even if international guidelines are available. Materials and Methods: We conducted a pattern of care survey to assess the management of patients with anal cancer in Italy (38 questions). We analyzed 58 questionnaires. Results: Most of the respondents work in public and/or university hospitals (75.8%) in northern Italy (65.5%). The majority (88.0%) treat less than 20 patients/year. Common examinations for diagnosis and staging are anorectal endoscopy (84.5%), computed tomography scan (86.2%) and pelvic magnetic resonance imaging (MRI) (96.5%). The most frequently prescribed dose to primary tumor is 50–54 Gy (46.5–58.6%) for early stage disease and 54–59.4 Gy (62.1–32.8%) for locally advanced cases. Elective volumes are prescribed around 45 Gy (94.8%). Most participants use volumetric intensity modulated radiotherapy (89.7%) and a simultaneous integrated boost (84.5%). Concurrent radiotherapy, 5-fluorouracil and mitomycin is considered the standard of care (70.6%). Capecitabine is less frequently used (34.4%). Induction chemotherapy is an option for extensive localized disease (65.5%). Consolidation chemotherapy is rarely used (18.9%). A response evaluation is conducted at 26–30 weeks (63.9%) with a pelvic MRI (91.4%). Follow-up is generally run by the multidisciplinary tumor board (62.1%). Conclusions: Differences were observed for radiotherapy dose prescription, calling for a consensus to harmonize treatment strategies.

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Cemiplimab as first intervention for patients with locally advanced cutaneous squamous cell carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.10065 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 10065-10065

Author(s):

Jennifer Lynn Atlas ◽

Marina Kanos ◽

James Thomas Symanowski ◽

Daniel Brickman ◽

Meghan Forster ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Adverse Events ◽

Cell Carcinoma ◽

Squamous Cell ◽

Early Stage ◽

Locally Advanced ◽

Cutaneous Squamous Cell Carcinoma ◽

Nodal Involvement ◽

Early Stage Disease ◽

Measurable Disease

10065 Cemiplimab as First Intervention for Patients with Locally Advanced Cutaneous Squamous Cell Carcinoma (cSCC) Background: Cutaneous squamous cell carcinoma is the second most common non-melanoma skin cancer. Early stage disease is managed with local intervention in the form of surgery or radiation and translates into cure for greater than 95% of the patients. Patients with high risk disease who have large primary lesions, neural, or nodal involvement are usually not amenable to cure with local intervention and may experience significant morbidity, disfigurement, or functional deficits. These patients had no effective systemic treatment options until recent approval of cemiplimab. We report the outcomes for upfront treatment with cemiplimab in locally advanced cSCC. Methods: This is a single institution retrospective study of patients with locally advanced cSCC defined as those requiring more than simple excision and/or complex repair or regional disease with nodal involvement who received at least two doses of cemiplimab between January 1, 2018 through January 17, 2020. Patients with radiologically measurable disease had response evaluated per RECIST criteria. Patients who had no measurable disease had their clinical response (complete resolution or healing of primary lesion) assessed per treating physician and need or lack of local intervention documented. Adverse events were assessed and graded per CTCAE criteria. The primary end point was to ascertain the need for local intervention. Results: Thirty six patients were eligible. Twenty-two (61%) patients treated with upfront cemiplimab were able to avoid local intervention with surgery and/or radiation; four patients progressed or died on treatment. Three (8%) patients received local intervention. Eleven (31%) patients are still receiving cemiplimab and local intervention decision is pending. The overall response rate was 69% and the clinical benefit rate was 92%. The median treatment duration was six months and the median number of doses received was six. Adverse events occurred in 31% of patients; the most common adverse event was dermatitis. Conclusions: Upfront treatment with cemiplimab in patients with locally advanced cSCC obviated need for disfiguring/complex surgery or radiation in majority of patients. Cemiplimab was tolerated well; no new safety signals were observed. Neo-adjuvant phase II study is in development.

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Expression of immune cell markers and tumor markers in patients with cervical cancer

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001254 ◽

2020 ◽

Vol 30 (7) ◽

pp. 969-974

Author(s):

Liming Zhang ◽

Hui Zhang ◽

Yuheng Huang ◽

Xiaowei Xi ◽

Yunyan Sun

Keyword(s):

Cervical Cancer ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Carcinoembryonic Antigen ◽

Tumor Markers ◽

Squamous Cell ◽

Early Stage ◽

Locally Advanced ◽

Control Group ◽

Healthy Women

ObjectiveCervical cancer is one of the most common cancers worldwide, and immune function may impact disease progression. Serum markers may also be associated with diagnosis and progression. The aim of this study was to explore the clinical usefulness of determining the levels of peripheral blood immune cells and serum tumor markers in predicting diagnosis and prognosis of patients with cervical cancer.Methods82 patients with cervical cancer (early stage group: IA–IB1 and IIA1; locally advanced group: IB2 and IIA2), 54 patients with cervical intra-epithelial neoplasia (CIN), and 54 healthy women (control group) were recruited. Inclusion criteria were: (1) patients whose cervical lesions were determined based on biopsy; and (2) patients who had not undergone immunotherapy, chemotherapy, or radiotherapy. The exclusion criteria were as follows: (1) patients with a history of other malignant tumors; (2) patients with heart, kidney, and other organ failure; (3) patients with immune diseases; and (4) pregnant or lactating women. The levels of immunocytes and tumor markers were assayed. The relationships among histopathologic factors were analyzed. The correlation between the levels of immunocytes and tumor markers in patients with different degrees of cervical lesions (pre-invasive or cancer) and healthy women was evaluated.ResultsThe squamous cell carcinoma antigen and carcinoembryonic antigen levels in the control group and the CIN group were significantly lower than those in the cervical cancer groups (p<0.01). The incidence of lymph node metastasis in the early stage and locally advanced groups were 22.9% (11/48) and 46.2% (12/26), respectively, and 58.8% (20/34) and 7.5% (3/37) in the positive and negative lymphovascular invasion groups, respectively (p<0.05). The levels of CD8+ and CD8+ CD28+ T cells in the early stage group were markedly lower than those in the CIN group and the control group (p=0.014, p=0.008, respectively). The ratio of CD4+CD25+/CD4+ in the cervical cancer groups was significantly higher than in the control group (p<0.01). The increased serum squamous cell carcinoma and carcinoembryonic antigen levels and CD4+CD25+/CD4+ ratio were risk factors for cervical cancer by logistic regression analysis (p<0.05).ConclusionsIn patients with cervical cancer, immune function was impaired compared with that in healthy women and patients with CIN, while squamous cell carcinoma and carcinoembryonic antigen levels were increased. Combined detection of the levels of peripheral blood immune cells and serum tumor markers may be helpful for early detection, diagnosis, and prognosis evaluation of patients with cervical cancer.

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Demographics and incidence of anal squamous cell carcinoma in people living in high HIV prevalence geographical areas

Sexually Transmitted Infections ◽

10.1136/sextrans-2021-055271 ◽

2021 ◽

pp. sextrans-2021-055271

Author(s):

Danielle Rebecca Louise Brogden ◽

Christos Kontovounisios ◽

Sundhiya Mandalia ◽

Paris Tekkis ◽

Sarah Catherine Mills

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Early Stage ◽

Incidence Rates ◽

Hiv Prevalence ◽

People Living With Hiv ◽

Early Stage Disease ◽

Anal Squamous Cell Carcinoma ◽

Stage Disease

ObjectivesAnal squamous cell carcinoma (ASCC) is an uncommon cancer that is rapidly increasing in incidence. HIV is a risk factor in the development of ASCC, and it is thought that the rapidly increasing incidence in men is related to increasing numbers of people living with HIV (PLWH). We undertook a population-based study comparing the demographics and incidence of ASCC in patients residing high HIV prevalence areas in England to patients living in average HIV prevalence areas in England.MethodsThis is a cross-sectional study following the ‘Strengthening the Reporting of Observational Studies in Epidemiology’ statement. Demographic data and incidence rates of ASCC within Clinical Commissioning Groups (CCGs) between 2013 and 2018 were extracted from the Cancer Outcomes and Services Dataset. CCGs were then stratified by HIV prevalence from data given by Public Health England, and high HIV prevalence geographical areas were compared with average HIV geographical areas.ResultsPatients in high HIV areas were more likely to be young and male with higher levels of social deprivation. Incidence rates in men between 2013 and 2017 were higher in high HIV areas than average HIV areas with a rapidly increasing incidence rates in early-stage disease and a 79.1% reduction in incidence of metastatic stage 4 disease.Whereas women in high HIV areas had lower ASCC incidence than the national average and a low incidence of early-stage disease; however, metastatic disease in women had quintupled in incidence in high HIV areas since 2013.ConclusionsPatients presenting with ASCC in high HIV geographical areas have different demographics to patients presenting in average HIV geographical areas. This may be related to screening programmes for PLWH in high HIV areas.

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Squamous cell carcinoma of the head and neck (SCCHN) in patients reporting human immunodeficiency virus (HIV) infection: A retrospective case series

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.5570 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 5570-5570 ◽

Cited By ~ 1

Author(s):

M. Haigentz ◽

G. Jung ◽

M. Garg ◽

R. Owen ◽

B. Schiff ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Hiv Infection ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Early Stage ◽

Case Series ◽

Second Primary ◽

Smoking Cessation Counseling ◽

Early Stage Disease

5570 Background: Although Squamous Cell Carcinoma of the Head and Neck (SCCHN) is a non-AIDS defining malignancy, its risk is greater in HIV-positive populations for unclear reasons. Very limited data exist on the clinical presentation, treatment toxicities and outcomes of HIV infected pts with SCCHN, a population frequently excluded from participation in clinical trials. Methods: We present a large case series of HIV infected pts with SCCHN who were recently treated at a single institution. Retrospective chart reviews were performed by treating physicians. Results are reported with descriptive statistics. Results: Thirty individuals with SCCHN reporting HIV infection have been treated by the collaborating physicians from 1997–2005; all were smokers. The average age at diagnosis of SCCHN was 49.3 years (range 33–62), and interestingly, a relatively large number were female (13 of 30, 43%). The median CD4 count of pts was 374/μL, and most pts reported a history of antiretroviral therapy. The most frequent sites of primary disease were the larynx (13 pts, 43%, mostly supraglottic) and oropharynx (13 pts, 43%). Although most patients (87%) presented with advanced (stage III and IV) disease, a few (4 pts, 13%) had stage II disease. Although 12 pts underwent surgical resections for primary treatment, 16 pts underwent primary nonsurgical therapy, including 8 pts treated with chemoradiotherapy. Therapy related toxicities were expected and did not appear different from those observed in immunocompetent individuals. Eight pts had recurrence (7 locoregional/1 distant), and 5 pts died from recurrent/metastatic disease. Three pts had second primary cancers. Conclusions: HIV-infected individuals with SCCHN are generally young smokers, both male and female, receiving active treatment against HIV. The detection of a proportion of pts with early stage disease further supports the role for aggressive smoking cessation counseling and screening efforts for SCCHN in HIV infected populations. Additionally, HIV infection is not a contraindication to aggressive organ-preserving regimens for SCCHN pts with otherwise good functional status. A case-control clinical and pathologic study of SCCHN in HIV infection is planned. No significant financial relationships to disclose.

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