Therapy for squamous-cell carcinoma of the anus in HIV-positive patients.

Introduction: Squamous-cell carcinoma of the anus (SCCA) is one of the most common cancers arising in people living with human immunodeficiency virus (HIV). However, these patients have been underrepresented in clinical trials of SCCA-directed therapies, which limits treatment recommendations. We carried out an extensive literature review of treatment outcomes of HIV-positive patients with SCCA. Methods: We sought the Medline® database to identify studies, meta-analyses, and systematic reviews on the efficacy and toxicity of treatments for patients with SCCA and HIV. Results: Thirty-seven studies were included. HIV-positive patients with SCCA were younger and predominantly male. The overall complete response rate after chemoradiotherapy is ∼80%, but locoregional recurrence and survival seems worse. While toxicity after chemoradiotherapy appears to be worse in HIV-positive patients in the first published series, recent analysis of HIV-positive patients treated with intensity-modulated radiotherapy did not show a difference in tolerance. Conclusions: The evidence to guide treatments for HIV-positive patients with SCCA is weak. Overall, patients with preserved immunity should not be spared of full chemoradiation in localized disease. Recent clinical trials of immune checkpoint inhibitors are currently enrolling HIV-positive patients and will help define the role of immunotherapy for these patients.