A phase II study of modified FOLFOX as first-line chemotherapy in advanced small bowel adenocarcinoma

Xiang, Xiao; Liu, Ya Wen; Zhang, Ling; Qiu, Feng; Yu, Feng; Zhan, Zheng Yu; Mao, Feng; Yan, Jun; Jin-yuan, Zhao; Xiong, Jian

doi:10.1097/cad.0b013e328350dd0d

Cited by 94 publications

(89 citation statements)

References 31 publications

(40 reference statements)

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“…9 The combination of 5-FU and a platinum-based agent has been considered more effective than other regimens such as oxaliplatinbased chemotherapy. 25,26 The main challenge for the near future is to identify molecular markers involved in small bowel carcinogenesis that predict chemosensitivity, and thus to improve survival. 5 Overman et al 27 observed that a high proportion of small intestinal adenocarcinomas express both EGFR and vascular endothelial growth factor (VEGF), suggesting that these patients may benefit from therapeutic strategies targeting EGFR and VEGF.…”

Section: Discussionmentioning

confidence: 99%

“…Several retrospective studies have indicated that chemotherapy prolongs overall survival in patients with advanced small intestinal adenocarcinomas, but there is no standard frontline regimen owing to a lack of randomized trials. 5,25 Patients with advanced small intestinal adenocarcinomas are often treated with the same chemotherapy regimens as patients with advanced colorectal cancers or gastric cancers, especially 5-fluorouracil (FU) or 5-FU-based schedules. 9 The combination of 5-FU and a platinum-based agent has been considered more effective than other regimens such as oxaliplatinbased chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

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Clinicopathologic and prognostic associations of KRAS and BRAF mutations in small intestinal adenocarcinoma

Jun

Kim

et al. 2016

Modern Pathology

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Activating KRAS and/or BRAF mutations have been identified as predictors of resistance to anti-epidermal growth factor receptor (EGFR) chemotherapy in colorectal cancer. But the status of KRAS and BRAF mutations and their clinicopathologic and prognostic significance has not been extensively evaluated in small intestinal adenocarcinomas. In this work, the KRAS and BRAF genes in 190 surgically resected small intestinal adenocarcinoma cases were sequenced and their association with various clinicopathologic variables, including survival of the patients, was analyzed. KRAS or BRAF mutations were observed in 63 (33%) cases. Sixty-one cases had KRAS mutations and 2 had BRAF mutations and the two types of mutation were mutually exclusive. The majority of KRAS mutations were G4A transition (43/61 cases, 71%) or p.G12D (31/61 cases, 51%). The patients with mutant KRAS tended to have higher pT classifications (P = 0.034) and more frequent pancreatic invasion (P = 0.020) than those with wild-type KRAS. Multivariate logistic regression analysis showed that certain mutated KRAS subtypes (G4A transitions and G12D mutations) were significantly correlated with higher pT classification (P = 0.015 and 0.004, respectively) than wild-type KRAS and other KRAS mutations. The patients with KRAS or BRAF mutation had a tendency to shorter overall survival than those with wild-type KRAS and BRAF (P = 0.148), but subgroup analysis demonstrated the patients with KRAS mutations showed worse survival (median, 46.0 months; P = 0.046) than those with wild-type KRAS (85.4 months) in lower pT classification (pT1-pT3) group. In summary, KRAS and, infrequently, BRAF mutations are observed in a subset of small intestinal adenocarcinomas, and are associated with higher pT classification and more frequent pancreatic invasion. KRAS mutation is a poor prognostic predictor in patients with lower pT classification tumors. Anti-EGFR targeted therapy could be applied to about two-thirds of small intestinal adenocarcinoma patients, namely those with wildtype KRAS and BRAF if they have metastatic disease, similar to colorectal cancer patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinicopathologic and prognostic associations of KRAS and BRAF mutations in small intestinal adenocarcinoma

Jun

Kim

et al. 2016

Modern Pathology

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“…It transpires that the protocol used for treating colorectal adenocarcinoma has shown a survival benefit for SBA patients. Of the four prospective clinical trials reported, three studies combining fluoropyrimidine with oxaliplatin have shown similar performance with response rates (RR) of 42% to 50% and a median time to progression (TTP), ranging from 7.8 to 9.8 months [1,[11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Small bowel adenocarcinoma (SBA) — a case report

Polczyk

2017

Nowotwory. Journal of Oncology

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Backround. Small bowel cancers account for less than 0.5% of all malignancies and approximately 1-3% of gastrointestinal tract malignancies. The two major tumour types are carcinoid and adenocarcinoma. The latter is most commonly found in the duodenum and jejunum, but least often in the ileum. Case presentation. We present a case study of a 67-year-old woman with small bowel adenocarcinoma (SBA) of the ileum. The patient was admitted to the hospital with nonspecific, persistent, recurrent pain in her upper abdomen and with suspected subileus. Previously performed clinical investigation (i.e. colonoscopy, computed tomography scans -CT scans, small bowel follow-through) didn't reveal any abnormalities. At laparotomy we discovered a round mass obstructing the ileal lumen at about 40 cm from the Bauhin valve. A tumour was then resected within its surgical margins. Pathologic examination revealed an ileal adenocarcinoma and an infiltration of the local adipose tissue (Adenocarcinoma G3 partim gelatinosum), with no evidence of metastatic lesions in the lymph nodes nor into other organs (pT3N0M0; the clinical stage IIA). Further oncological treatment was thereby advised. Conclusions. A low prevalence and non-specific symptoms along without any clearly established diagnostic nor treatment protocols makes a final diagnosis difficult and thus merits further diagnostic investigation, particularly the testing of specific biochemical or immunological markers. NOWOTWORY J Oncol 2017; 67, 2: 137-141

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“…Several phase II studies examining a variety of protocols with different OS have been published [21][22][23][24][25]. There are also retrospective single centre experiences comparing different regimens [5,15,16,20,[26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

A retrospective review of chemotherapy for patients with small bowel adenocarcinoma in British Columbia.

Duerr

Ellard

Cormier

et al. 2013

JCO

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Background: Small bowel adenocarcinoma (SBA) is associated with a poor prognosis. It is an uncommon malignancy and therefore difficult to study. Randomized phase III trials are not available to guide best approaches. The Provincial Cancer Registry of the British Columbia Cancer Agency contains long-term data on patients with SBA. The authors analyzed characteristics and treatment outcomes for SBA patients diagnosed between 1990 and 2008. Material and methods: Charts of 150 patients with a histological diagnosis of SBA were retrospectively analyzed. Epidemiological and treatment data were collected. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan-Meier method. Results: Baseline characteristics, such as median age at diagnosis (64.5 years), tumor stage (I-II 33%, III-IV 58%, unknown 9%), and location (duodenum 48%, jejunum 31%, ileum 21%) were consistent with published data. 55% of patients had a positive family history of cancer. DFS and OS of 29 patients treated with adjuvant chemotherapy were not significantly different to that of 47 patients without (p = 1 and p = 0.211, respectively). In the palliative setting patients treated with polychemotherapy (21 patients) had statistically better OS than patients treated with monochemotherapy (12 patients) (p = 0.0228). Conclusions: Our study suggests a survival benefit for advanced-stage SBA patients treated with poly-versus monochemotherapy. This, however, was a retrospective analysis with several potential confounders. Nevertheless, our study adds to the evidence suggesting that chemotherapy may be beneficial for patients with SBA, at least in the palliative setting.

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A phase II study of modified FOLFOX as first-line chemotherapy in advanced small bowel adenocarcinoma

Cited by 94 publications

References 31 publications

Clinicopathologic and prognostic associations of KRAS and BRAF mutations in small intestinal adenocarcinoma

Clinicopathologic and prognostic associations of KRAS and BRAF mutations in small intestinal adenocarcinoma

Small bowel adenocarcinoma (SBA) — a case report

A retrospective review of chemotherapy for patients with small bowel adenocarcinoma in British Columbia.

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