Anti epidermal growth factor receptor therapy in small bowel adenocarcinoma

Abstract

Rationale:Small bowel adenocarcinoma (SBA) is an uncommon gastrointestinal cancer, thus limited data about treatment for advanced disease are available. The lack of specific guidelines has justified the use of therapeutic protocols usually applied in advanced colorectal cancer. Few and preliminary data have suggested possible clinical benefit from the use of target therapy such as bevacizumab and cetuximab.Patient concerns:We present the case of a young woman who was admitted to the emergency department for acute abdominal pain, nausea, and vomiting related to a jejunal stenosis.Diagnoses:An enteroscopy with jejunal biopsy showed poorly differentiated cancerous cells suggestive for primary intestinal cancer. There were no signs of metastatic disease at radiological evaluation. A jejunal resection was subsequently carried out and the diagnosis of mucinous adenocarcinoma of the jejunum was confirmed.Interventions:The computed tomography scan performed 1 month after surgery showed metastatic disease. Therefore, the patient received combined protocols of chemotherapy and either bevacizumab or the anti-epidermal growth factor receptor (EGFR) panitumumab.Outcomes:A partial response (PR) was achieved with Folfox plus panitumumab and a maintenance therapy with panitumumab is being conducted with a mild toxicity and a progression free survival of 19 months since the beginning of panitumumab.Lessons:This is, to the best of our knowledge, the first report in the literature of a patient with SBA who has benefitted from panitumumab with an overall survival of 83 months.

The Risk of Malignancies in Celiac Disease—A Literature Review

“…Tumor molecular analysis may provide the rationale for the use of targeted therapies. For instance, in several case reports of metastatic SBC, the presence of KRAS wild-type has been demonstrated to predict responsiveness to antiepidermal growth factor receptor monoclonal antibodies (cetuximab and panitumumab) alone or combined with chemotherapy [ 207 , 208 ]. In contrast, nine patients with metastatic SBC KRAS wild-type showed no response to panitumumab in a phase 2 clinical trial (7 showing progression and 2 showing stable disease) [ 209 ].…”

Small Bowel Carcinomas Associated with Immune-Mediated Intestinal Disorders: The Current Knowledge

“…Several molecular alterations may suggest the response to novel therapies. In particular, KRAS wild-type mutational status has been demonstrated to predict responsiveness to anti-epidermal growth factor receptor monoclonal antibodies cetuximab and panitumumab alone or combined with chemotherapy in metastatic SBC in several case reports [76,77]. Conversely, a recent phase 2 clinical trial of panitumumab showed no response rate of this drug in nine patients with metastatic KRAS wild-type SBC, of which one was associated to inflammatory bowel disease and two to Lynch syndrome [78].…”

Small Bowel Carcinomas Associated with Immune-Mediated Intestinal Disorders: the Current Knowledge

“…Several molecular alterations may suggest the response to novel therapies. In particular, KRAS wild-type mutational status has been demonstrated to predict responsiveness to anti-epidermal growth factor receptor monoclonal antibodies cetuximab and panitumumab alone or combined with chemotherapy in metastatic SBC in several case reports [75,77]. Conversely, a recent phase 2 clinical trial of panitumumab showed no response rate of this drug in nine patients with metastatic KRAS wild-type SBC, of which one was associated to inflammatory bowel disease and two to Lynch syndrome [78].…”