Disparities in the Treatment and Outcome of Anal Cancer in Public and Private Hospital Patients

were treated with infusional 5-FU (1000 mg/m2/day for 4 days) and MMC (10 mg/m2) during wks 1 and 5 (5-FU group) and 27 pts were treated with cape (825 mg/m2 BID) M-F throughout RT and MMC (10 mg/m2) during wks 1 and 5 (Cape group). Data regarding pt, tumor and treatment characteristics and acute heme toxicity according to CTCAE v4.0 based on weekly CBC performed during CRTwere recorded. The incidence of Grade 3/4 heme toxicity and the duration of treatment were compared between the two groups. Results: The median age at diagnosis was 59 yrs and 64 (72%) were women. Patient characteristics were similar between the two groups. All pts were treated with IMRT delivered in a median of 28 fractions and with a median dose of 56 Gy (range, 49-56 Gy) for both groups. Twenty pts (31%) in the 5-FU group developed Grade 3/4 neutropenia while only one pt (4%) had Grade 3/4 neutropenia in the cape group (p Z 0.002). Grade 3/4 thrombocytopenia and anemia occurred in 8 pts (13%) and 2 pts (3%), respectively, in the 5-FU group and none of the pts in the cape group. Treatment breaks were necessary for 26 pts (42%) treated with 5-FU and 5 pts (19%) treated with cape (p Z 0.03). The most common reasons for delaying treatment in the 5-FU group were Grade 3/4 neutropenia or mucositis, while in the cape group, they were diarrhea (n Z 2), rectovaginal fistula (n Z 1), neutropenia (n Z 1), and Hurricane Sandy (n Z 1). Median treatment duration was 40 days in the 5-FU group and 37 days in the cape group (p Z 0.002). Conclusions: An adequately powered non-inferiority comparison of cape vs 5-FU is not numerically feasible in ASCC. Our data suggest that cape is associated with decreased Grade 3/4 heme toxicity when compared to standard 5-FU for pts undergoing definitive CRT for ASCC. The reduction in treatment breaks due to heme toxicity may be expected to yield improved outcomes. Moreover, since cape with MMC appears to be better tolerated, this regimen may serve as a backbone for further studies evaluating novel agents with CRT for ASCC. Author Disclosure: K.A. Goodman: None. D. Rothenstein: None. C. Lajhem: None. A. Wu: None. A. Cercek: None. L.B. Saltz: None.