Treating precancerous lesions reduces anal cancer risk in people with HIV
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Treating high-grade squamous intraepithelial lesions — primarily with office-based electrocautery — led to an almost 60% reduction in anal cancer incidence among people with HIV, according to the results of a randomized controlled trial.
Joel Palefsky, MD, a professor of medicine in the department of infectious diseases at the University of California, San Francisco, presented results from the phase 3 ANCHOR trial at the virtual Conference on Retroviruses and Opportunistic Infections.
“Anal cancer is the fourth most common cancer among people living with HIV, and like cervical cancer, may be preventable through screening for and treating the anal cancer precursor lesion — high-grade squamous intraepithelial lesions (HSIL),” Palefsky told Healio.
Palefsky said the findings — initially reported last fall before peer review because of their significance — “could change standard of care for people living with HIV and others at high risk of anal cancer.”
In the trial, Palefsky and colleagues studied the ability of anal HSIL treatment to reduce anal cancer incidence compared with active monitoring (AM). They screened people with HIV aged 35 years or older for anal HSIL using high-resolution anoscopy and randomly assigned any eligible patients with biopsy-proven anal HSIL in a 1:1 ratio to treatment until resolution or AM without treatment.
They screened a total of 10,723 people with HIV at 25 U.S. sites and assigned 2,237 to the treatment arm and 2,222 to the AM arm. Among these patients, 4,446 (99.7%) were included in the time-to-incident cancer analysis.
Palefsky and colleagues reported that 92.7% of study participants were treated with office-based electrocautery, and 8.2% received topical 5-fluorouracil cream or imiquimod.
Overall, nine cases of anal cancer were diagnosed in the treatment arm and 21 in the AM arm. The cancer incidence in the treatment arm was 173 per every 100,000 person-years of follow-up compared with 402 per every 100,000 person-years in the AM arm, a 57% reduction in anal cancer (95% CI, 6%-80%).
“These data support inclusion of screening and treating anal HSIL as standard of care for anal cancer prevention in people living with HIV 35 year old or older,” Palefksy said. “Our data are also likely relevant for other groups at risk of anal cancer.”
Perspective
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This is one of the most important presentations at this year's Conference on Retroviruses and Opportunistic Infections. It shows that detecting and treating precancerous anal lesions associated with HPV infection can decrease the later development of cancer compared with active surveillance without intervention. Obviously, we hope that widespread HPV vaccine use may decrease the need for this intervention, but because the delay from initial HPV infection to precancerous lesions is long, the strategy in this trial will be required for many years.
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Palefsky J, et al. LB 106. Presented at: Conference on Retroviruses and Opportunistic Infections; Feb. 12-16, 2022 (virtual meeting).
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