Locally advanced anal canal carcinoma: is the addition of cetuximab the answer?

Carcinoma of the anal canal is a rare disease accounting 7.270 estimated new cancer cases in 2015, with increasing incidence over the last decades [1]. The efficacy of radiation therapy combined with chemotherapy (CRT) as treatment for anal canal carcinoma has been convincingly proven. Prior to the 1970s, treatment consisted of radical surgery with abdominoperineal resection. Relying on Nigro’s intuitions, several randomized clinical trials tested the use of radiotherapy combined with chemotherapy and demonstrated a significantly higher colostomy-free survival with the addition of mitomycin-C (MMC) to infusional 5-fluorouracil (5-FU) and radiation. This method was first described by Nigro in 1974. Since then, no other effective treatment was developed— two randomized trials tested whether cisplatin (CDDP) could be used instead of MMC to improve local and distant control, but results failed in their objective