Treatment strategies for metastatic small bowel adenocarcinoma

Résumé 0

Although their incidence is currently increasing, small bowel adenocarcinomas (SBAs) are rare tumors and account for only 2–5 percent of all digestive cancers. Due to their rarity, very little data is available in the literature, and the main published studies have low levels of evidence (phase II, retrospective studies). To date, recommended first-line treatment for unresectable or metastatic SBAs is bi-chemotherapy using the FOLFOX regimen. In the second-line setting after progression under platinum salt, FOLFIRI seems to be the preferred treatment option, although other chemotherapies may also be discussed (taxanes, gemcitabine). Although major advances have been made when it comes to molecular signaling pathways and the tumor immune microenvironment, the corresponding treatment advances (personalized medicine, targeted therapies) have not yet demonstrated significant benefits in cases of metastatic SBA. Promising results have recently been reported with the use of immunotherapy in unresectable SBA with microsatellite instability (7 percent of metastatic SBAs). Screening for an MSI phenotype should therefore be routinely performed at diagnosis. Due to the rarity of SBAs, their inclusion in clinical trials should be prioritized whenever possible.