When administered before chemoradiation, the common anti-cancer drug cisplatin neither improved disease-free survival nor reduced the number of colostomies needed when compared to the standard treatment for patients with anal canal cancer, according to a study published in the April 23 issue of the Journal of the American Medical Association.
In the largest cooperative Phase III randomised controlled trial of its kind, a multicentre research team led by Jaffer Ajani, M.D., professor in the Department of Gastrointestinal Medical Oncology at The University of Texas M. D. Anderson Cancer Center, compared the standard treatment regimen of fluorouracil plus mitomycin and radiotherapy to fluorouracil plus cisplatin and radiotherapy in 644 patients with anal canal cancer.
The five-year disease-free survival rate was 60% in the mitomycin-based group and 54% in the cisplatin-based group. The five-year overall survival rate was 75% in patients receiving mitomycin versus 70% receiving cisplatin, with more cancer-related deaths in the cisplatin-based group (54 patients) compared to mitomycin-based group (28 patients).
Patients who received cisplatin-based treatment resulted in significantly higher rates of colostomy (19% versus 10%).
It is widely held among practicing oncologists that the colostomy procedure, which creates an alternative exit from the colon to divert waste, should only be used as a last resort in the treatment of anal canal cancer due to its considerable affect on the patient’s quality of life.
“Based on preliminary data from smaller trials that suggested considerable sensitivity to the fluorouracil plus cisplatin combination, cisplatin has gained popularity among oncologists as a drug to treat anal canal cancer,” said Dr Ajani. “However, it is clear from this data that cisplatin is not the drug to use and its use should be discontinued in standard therapy.”