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Systemic Treatments for Advanced Small Bowel Adenocarcinoma: A Systematic Review
Paola Di Nardo1, Silvio Ken Garattini2, Elena Torrisi3
1Department of Medical Oncology, CRO Aviano, National Cancer Institute, IRCCS, 33081 Aviano, Italy.
Abstract:
Small bowel adenocarcinoma (SBA) is a rare disease for which scarce evidence is available. We summarized data available on systemic treatment of advanced SBA.
Methods:
Scientific literature was evaluated to find phase II or phase III clinical trials on systemic treatment for advanced SBA. MeSH terms were selected and combined for the initial search, then inclusion and exclusion criteria were set in a search protocol. Four medical oncologists looked for evidence on Medline, EMBASE and Cochrane databases. Moreover, abstracts from 2016 to June 2021 from the American Society for Clinical Oncology, European Society for Medical Oncology, Gastrointestinal Cancer Symposium and World Congress on Gastrointestinal Cancer were browsed. The selected studies, matching the inclusion and exclusion criteria, were finally tabulated and analyzed.
Results:
The trials finally selected were 18 phase II/III clinical trials. Four small phase II trials support the activity of oxaliplatin-based doublets in first-line treatment (CAPOX and mFOLFOX).
Conclusion:
No good level evidence is available on the use of bevacizumab, anti-epidermal growth factor receptor, targeted agents or immunotherapy. First-line treatments are largely derived from colorectal cancer protocols, mainly oxaliplatin-based doublets.
Insights
Systemic treatment for advanced small bowel adenocarcinoma (SBA) is limited. Oxaliplatin-based doublets show activity in first-line therapy, but evidence for other agents like bevacizumab or immunotherapy is lacking.
Area of Science:
- Oncology
- Gastrointestinal Oncology
- Clinical Trials
Background:
- Small bowel adenocarcinoma (SBA) is a rare malignancy with limited available evidence regarding systemic treatment options.
- Advanced SBA presents significant challenges due to its rarity and the scarcity of dedicated research.
Purpose of the Study:
- To summarize the available data on systemic treatment for advanced small bowel adenocarcinoma.
- To evaluate the efficacy of different therapeutic strategies based on existing clinical trials.
Main Methods:
- A systematic literature review was conducted, focusing on phase II or III clinical trials for advanced SBA.
- Searches were performed across major medical databases (Medline, EMBASE, Cochrane) and key oncology conference abstracts (2016-2021).
- Inclusion/exclusion criteria were applied, and selected studies were analyzed.
Main Results:
- Eighteen phase II/III clinical trials met the inclusion criteria.
- Four small phase II trials indicated activity for oxaliplatin-based doublets (CAPOX, mFOLFOX) in first-line treatment of advanced SBA.
Conclusions:
- Currently, there is a lack of high-level evidence supporting the use of bevacizumab, anti-EGFR agents, targeted therapies, or immunotherapy in advanced SBA.
- First-line treatment strategies for advanced SBA are primarily extrapolated from colorectal cancer protocols, with oxaliplatin-based doublets being a common approach.
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