What are the latest pharmacotherapy options for small bowel adenocarcinoma?
Marie Lourdes Ynson1, Frank Senatore, Constantin A Dasanu
1Saint Francis Hospital and Medical Center, Department of Medicine , Hartford, CT , USA mynsonmd@gmail.com.
Abstract:
Incidence of small bowel adenocarcinoma is slowly but steadily increasing. As we gain more knowledge of the molecular basis of this disease, we may be able to approach it via using novel biologic or targeted therapies with or without traditional chemotherapy agents. In the meantime, early diagnosis is still best as it prompts early surgical resection and offers potential cure. The role of adjuvant and neoadjuvant therapy is currently being explored in clinical trials. Several clinical trials have suggested that first-line chemotherapy for patients with metastatic disease should consist of either 5-fluorouracil-leucovorin-oxalipatin or capecitabine-oxaliplatin, while 5-fluorouracil-leucovorin-irinotecan can be reserved for second-line treatment. However, we realize the limitations of these studies, given their small sample size and/or retrospective nature. Single-agent 5-fluorouracil/capecitabine should be considered in patients who are either intolerant to or experience significant side effects with oxaliplatin or irinotecan. We believe that cancers originating in the ampulla of Vater probably deserve a prospective randomized trial of cisplatin-gemcitabine, the current standard of therapy for advanced biliary malignancies.
Insights
Small bowel adenocarcinoma incidence is rising. Early diagnosis and surgical resection remain crucial, while novel targeted therapies and chemotherapy regimens are under investigation for metastatic disease.
Area of Science:
- Gastroenterology
- Medical Oncology
Background:
- Small bowel adenocarcinoma incidence is increasing, necessitating advanced treatment strategies.
- Current research focuses on molecular underpinnings to develop novel targeted and biologic therapies.
- Early diagnosis and surgical resection are paramount for potential cure in small bowel adenocarcinoma.
Discussion:
- First-line chemotherapy for metastatic disease often involves 5-fluorouracil-leucovorin-oxaliplatin or capecitabine-oxaliplatin, with 5-fluorouracil-leucovorin-irinotecan for second-line treatment.
- Limitations of current chemotherapy studies include small sample sizes and retrospective designs.
- Single-agent 5-fluorouracil/capecitabine is an option for patients intolerant to oxaliplatin or irinotecan.
Key Insights:
- Chemotherapy regimens like FOLFOX or CAPOX are suggested for first-line metastatic treatment.
- Second-line treatment options include FOLFIRI.
- Cisplatin-gemcitabine is proposed for ampullary cancers, aligning with advanced biliary malignancy standards.
Outlook:
- Adjuvant and neoadjuvant therapy roles are actively being explored in clinical trials.
- Prospective randomized trials are needed to establish optimal treatment for ampullary cancers.
- Advancements in understanding molecular pathways may lead to more effective targeted therapies.
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