title: Capecitabine in locally advanced anal cancer, do we need randomised evidence?
abstract: Standard treatment for locally advanced anal cancer is chemoradiotherapy with mitomycin C and fluorouracil. However, infusional fluorouracil requires central venous catheter placement potentiating risk of infection and thrombosis. Capecitabine which is an oral tumor activated fluoropyrimidine carbamate is an established treatment alternative to infusional fluorouracil for patients with gastrointestinal cancers. Areas covered: This review examines and discusses the current evidence for substitution of Capecitabine for infusional fluorouracil in locally advanced anal cancer. Two phase II studies, one phase I study and three retrospective reviews were identified. The rate of complete response and locoregional control with the use of Capecitabine in all of these studies ranged from 77% to 89.1% and 79% to 94% respectively, and these results are comparable with prior pivotal studies. The main toxicity with radiation and Capecitabine is radiation dermatitis occurring in 23% to 63% of patients. Despite high rates of radiation dermatitis, treatment completion rates were high, suggesting that it is a well tolerated protocol. Expert commentary: Capecitabine has been used widely in other gastrointestinal cancers, including rectal cancer in chemo-radiotherapy protocols, with proven efficacy and safety and could be a reasonable treatment alternative to fluorouracil in locally advanced anal cancer.
authors.affiliation: a Department of Medical Oncology , Adelaide Oncology and Haematology , North Adelaide , Australia.|b Department of Medical Oncology , Royal Adelaide Hospital , Adelaide , Australia.
authors.forename: Li Chia
authors.initials: LC
authors.lastname: Chong
authors.affiliation: a Department of Medical Oncology , Adelaide Oncology and Haematology , North Adelaide , Australia.
authors.forename: Tabitha
authors.initials: T
authors.lastname: Healey
authors.affiliation: a Department of Medical Oncology , Adelaide Oncology and Haematology , North Adelaide , Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Michele
authors.affiliation: c Department of Medical Oncology , The Queen Elizabeth Hospital and University of Adelaide , Adelaide , Australia.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Price
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage* / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001005:Anus Neoplasms / Q000473:pathology / Q000628:therapy*; D000069287:Capecitabine / Q000008:administration & dosage* / Q000009:adverse effects; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D016685:Mitomycin / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D016685:Mitomycin; D000069287:Capecitabine; D005472:Fluorouracil
keywords: Anal cancer; capecitabine; fluorouracil; stoma rate