Management of metastatic anal cancer

Metastatic SCCA is rare, with less than 10% of patients with metastatic disease at the index presentation of anal cancer. 10% to 20% developing metastatic recurrence after initial treatment with chemoradiotherapy. Metastasis is suspected in patients with red flag symptoms/signs who have a prior history of SCCA, risk factors for HPV/HIV infection, or those who are immunosuppressed. Diagnosis is established with biopsy, CT, and PET scans. The management of metastatic SCCA should involve a multidisciplinary team, with first-line treatment being chemotherapy, and second-line treatment involving immunotherapy. Identification of predictive biomarkers may personalize treatment options in the future. Ongoing clinical trials involving chemotherapy and immunotherapy combination, adoptive cellular therapy and vaccine therapy may challenge current treatment options in the future.