Panelists discuss how future research priorities include developing predictive biomarkers, exploring quadruple therapy combinations, determining optimal checkpoint inhibitor duration and sequencing strategies, incorporating immunotherapy into earlier treatment lines with chemoradiation, and utilizing circulating tumor DNA for prognostic monitoring after definitive therapy.
Panelists discuss how implementing combination immunotherapy in clinical practice faces institutional barriers, including formulary approval for retifanlimab and payer authorization challenges. They maintain that published dosing schedules should be followed rather than modifying treatment intervals to address patient access barriers.
Panelists discuss how biomarker development in anal cancer remains limited with PD-L1 status not influencing treatment decisions, although rare targets like HER2, PIK3CA aberrations, and RAS wild-type status for EGFR inhibitors may warrant next-generation sequencing testing for research purposes, while emphasizing honest discussions about palliative treatment goals and quality-of-life balance.
Panelists discuss how treatment selection between combination immunotherapy (IO) and chemotherapy alone should favor the FDA-approved carboplatin-paclitaxel-retifanlimab regimen for most patients with metastatic anal cancer, while avoiding checkpoint inhibitors in solid organ transplant recipients and maintaining that different checkpoint inhibitors are not necessarily interchangeable without specific trial data.
Panelists discuss how the PODIUM-303 study demonstrated improved progression-free survival (9.3 vs 7.4 months) and response rates (56% vs 44%) when adding retifanlimab to carboplatin-paclitaxel in first-line metastatic anal cancer, leading to FDA approval despite nonsignificant overall survival results due to 45% crossover in the interim analysis.
Panelists discuss how current NCCN guidelines for metastatic anal cancer recommend carboplatin-paclitaxel as preferred first-line therapy, with the recent addition of carboplatin-paclitaxel plus retifanlimab as category 2B evidence following FDA approval, while noting that induction chemotherapy for bulky disease remains case-specific without randomized data support.
Panelists discuss how a woman aged 55 years with T3N1M0 locally advanced squamous cell carcinoma represents a typical case for definitive chemoradiation therapy over surgical resection, emphasizing the importance of supportive care measures, including pain management, hydration monitoring, and patient education, to optimize treatment completion rates and minimize toxicity.
Panelists discuss how the evolution of anal cancer treatment began with the 1974 Nigro regimen combining 5-fluorouracil and mitomycin with radiation, which remains the preferred treatment approach despite alternative options like capecitabine, with modifications including day 28 mitomycin based on subsequent studies showing improved colostomy-free survival.
Panelists discuss how successful treatment of locally advanced anal cancer requires a multidisciplinary approach involving colorectal surgeons, radiation oncologists, pathologists, medical oncologists, and physician assistants. They emphasize the importance of proper histological classification to distinguish squamous cell carcinoma from adenocarcinoma.
Panelists discuss how diagnosis and staging of anal cancer involves digital rectal examination, high-resolution anoscopy with biopsy, p16 testing, and pelvic MRI for accurate staging, while considering patient factors like HIV status, treatment adherence capability, and comorbidities when planning curative intent therapy.
Panelists discuss how anal cancer epidemiology shows increasing incidence in both sexes with HPV infection as the primary risk factor, affecting predominantly women with a median age of 60, while emphasizing the need to dispel misconceptions linking HPV-related anal cancer to sexual practices.
Richard Kim, MD, walks through options in the frontline setting for patients with advanced staged hepatocellular carcinoma and how newer treatments have impacted this patient population.
Considerations for ongoing clinical trials that may shape the future treatment landscape of unresectable hepatocellular carcinoma.
Richard Kim, MD, shares insight on positive results from IMbrave150, which tested the frontline combination of atezolizumab and bevacizumab in patients with unresectable HCC.
A brief synopsis on optimal sequencing strategies for patients who have been diagnosed with unresectable hepatocellular carcinoma.
A comprehensive overview of the frontline treatment landscape for patients with unresectable HCC, including those who present with contraindications to standard-of-care therapy.
Expert Richard Kim, MD, reflects on the nature of HCC, particularly the challenges inherent in diagnosis and management.