Improved Outcomes in Locally Advanced Anal Cancer: The Role of Taxol, Ifosfamide, and Platinum Chemotherapy Prior to Standard Chemoradiation

Background Anal squamous cell carcinoma (SCC) is a rare but increasing malignancy, often associated with HPV infection. Standard treatment for locally advanced disease includes concurrent chemoradiotherapy (CRT) with 5-fluorouracil (5-FU) and mitomycin-C. Despite high response rates, recurrence remains a challenge, particularly in high-risk cases. Neoadjuvant chemotherapy with paclitaxel, ifosfamide, and cisplatin (TIP) has shown promise in other SCC types and may improve outcomes in anal cancer. Objective To evaluate the clinical outcomes of TIP chemotherapy followed by CRT in the treatment of locally advanced anal SCC. Methods We present a case series of three patients with locally advanced anal SCC treated with TIP chemotherapy followed by concurrent CRT. Clinical responses were assessed by imaging, and disease-free survival (DFS) was monitored. Results The first case is a 69-year-old female with T3N1M0 disease achieved marked tumor reduction after two cycles of TIP. Following CRT, she has remained disease-free for over 30 months. Our second case is a 72-year-old female with T2N0M0 disease received one cycle of TIP before omitting the second cycle due to hematologic toxicity. After CRT, she remains disease free for 9 years. Case three is a 64-year-old female with T4N0M0 disease (rectal and vaginal invasion) had significant tumor shrinkage after TIP. Following CRT, she has been disease-free for 11 years. Discussion Neoadjuvant TIP chemotherapy followed by CRT led to favorable outcomes, with all patients achieving long-term disease-free survival. Notably, the approach was well tolerated with manageable toxicity. These findings suggest that TIP chemotherapy may improve outcomes in high-risk anal SCC patients, particularly in those with large tumors or regional spread. Conclusion Neoadjuvant TIP chemotherapy combined with CRT appears to be a promising treatment strategy for locally advanced anal SCC. Larger studies are needed toconfirm its efficacy and determine optimal patient selection.