ANCHOR: treatment of anal high-grade squamous intraepithelial lesions to prevent anal cancer
Treating precancerous anal lesions in people living with HIV cut the rate of progression to anal cancer by 57 percent compared with monitoring alone, the first proof that anal cancer screening and treatment work.
Overview
Phase 3 trial of the AIDS Malignancy Consortium: 4,459 people living with HIV aged 35 or older with biopsy-proven anal high-grade squamous intraepithelial lesions were randomised to treatment (mostly office-based ablation, or topical fluorouracil or imiquimod, or excision) or active monitoring every six months; 4,446 were analysed.
At a median follow-up of 25.8 months, nine cancers were diagnosed in the treatment group (173 per 100,000 person-years) and 21 in the monitoring group (402 per 100,000 person-years), a 57 percent lower rate of progression (95% CI 6 to 80, p 0.03). The trial stopped early for efficacy.
- Anal cancer incidence 173 per 100,000 person-years (95% CI 90 to 332) with treatment versus 402 (262 to 616) with active monitoring.
- Rate of progression to anal cancer 57 percent lower with treatment (95% CI 6 to 80; p 0.03).
People living with HIV should be screened for anal high-grade lesions and treated when they are found; guidelines in the United States changed on this trial.
- Only 30 cancers occurred and follow-up was short; the trial was stopped early.
- Treatment modalities varied and the benefit for HIV-negative populations is inferred.
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