July 11, 2022 – The New England Journal of Medicine (NEJM) has published the results of a study by the Sylvester Comprehensive Cancer Center at the University of Miami Miller School and other researchers on anal cancer prevention in people living with HIV (PLHIV), likely to establish a new standard of care.
Results from the ANCHOR study, which evaluated 10,723 PLHIV and enrolled 4,446 from 25 US sites including Sylvester and Jackson Memorial Hospitals, show that treating high-grade squamous intraepithelial lesions (HSIL) that are potentially precancerous reduces anal risk significantly reduces cancer in people living with HIV compared to a wait-and-see approach.
Isabella Rosa-Cunha, MD, Principal Investigator, ANCHOR Study Centers at Sylvester and Jackson Memorial Hospital and Associate Professor of Medicine at the Miller School
The risk of anal cancer is higher in people with HIV than in the general population. According to Isabella Rosa-Cunha, MD, Principal Investigator for ANCHOR Study Centers at Sylvester and Jackson Memorial Hospital and Associate Professor of Medicine, anal cancer is biologically similar to cervical cancer in the sense that both are caused by HPV and precede HSIL at the Müller School.
“Finding and treating these lesions in cervical cancer prevention has been a game changer for women and has greatly reduced the overall rate of cervical cancer. This is the only prospective study showing a similar effect on anal cancer prevention,” said Dr. Pink Cunha.
Investigators looked at people living with HIV aged 35 and older, with biopsies showing they had anal HSIL. Subjects were randomized to either a treatment group in which their lesions were primarily treated with electrocautery or an active surveillance group with no treatment.
Reduced cancer incidence in treated participants
During the study, the 2,227 treated participants were diagnosed with nine cases of anal cancer, compared to 21 cancers in the 2,219 participants in the active surveillance group. The incidence of anal cancer was approximately 60% lower in the treatment arm, which is a significant finding.
“While treating precancerous anal lesions has room for improvement to further reduce or eliminate the risk of anal cancer in these patients, these data support the recommendation to include screening and treatment of anal HSIL for anal cancer prevention in people living with HIV,” said Dr . Rosa Cunha .
This study looked specifically at PLHIV, but finding and treating these lesions will likely improve anal cancer prevention in other high-risk groups, including HIV-negative men who have sex with men, transplant recipients, and women with HPV vulvar disease. Pink Cunha.
“This paper is already making a big impact. The CDC is evaluating its recommendations for anal cancer prevention in people living with HIV based on the ANCHOR study,” she said.
The National Cancer Institute, which funded the study, has approved the study to continue following these patients through 2025.
“There is a huge amount of data that has not yet been analyzed. The Miller School was among the top registries in the US, and there are a large body of specimens collected from participants that will likely help answer other important questions in the natural history of anal cancer,” said Dr. Pink Cunha.