Combination Chemotherapy in Advanced Small Bowel Adenocarcinoma

Abstract

Objective: To assess the efficacy of 5-fluorouracil (5-FU) and either platinum compounds or irinotecan in patients with advanced small bowel adenocarcinoma (SBA), for whom data on the efficacy of chemotherapy are scarce. Methods: We reviewed data on all patients with advanced SBA who received chemotherapy over a 9-year period at our institution. Results: Twenty patients with advanced SBA received a median of 6 cycles (range 2–15) of chemotherapy with 5-FU and either cisplatin (n = 15), carboplatin (n = 2), or oxaliplatin (n = 3). The overall response rate was 21%, and median progression-free and overall survival 8 and 14 months, respectively. Toxicity was moderate. Second-line chemotherapy with 5-FU and irinotecan resulted in disease stabilization in 4 (50%) of 8 patients (median progression-free survival: 5 months), and in a biological complete response in another patient with nonmeasurable peritoneal carcinomatosis, allowing surgical cytoreduction surgery and hyperthermic intraperitoneal chemotherapy. No tumor response or disease stabilization was seen among the patients who received protracted venous infusion of 5-FU (n = 4) or infusional 5-FU and cisplatin (n = 1) as second-line chemotherapy. Conclusion: Chemotherapy with 5-FU and platinum compounds seems effective and well-tolerated in patients with advanced SBA. 5-FU-irinotecan combination chemotherapy deserves further investigation in the first-line setting.

Multicenter Retrospective Study of 132 Patients with Unresectable Small Bowel Adenocarcinoma Treated with Chemotherapy

“…Fluoropyrimidines are generally considered to be the key drugs for SBA and other gastrointestinal cancers. Most regimens used in previously reported studies of chemotherapy for unresectable SBA included fluoropyrimidines; to date, there has been no active regimen without these drugs [11][12][13][14][15][16][17][18][19][20][21][22][23]. However, no prospective or retrospective study has clearly showed advantages of a combination regimen compared with fluoropyrimidine monotherapy for unresectable SBA with regard to PFS or OS times.…”

“…Fluorouracil (5-FU) is the most commonly used agent for the treatment of unresectable or recurrent SBA, and various 5-FU based regimens have been used [11][12][13][14][15][16][17][18][19][20][21][22][23]. In a retrospective analysis, Overman et al reported that combination therapy with 5-FU and platinum compounds showed more favorable results than other regimens [21].…”

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

“…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]. Current expert opinion favors use of a fluoropyrimidine-platinum combination in the first line [20,26,27].…”

Combination chemotherapy with cisplatin and irinotecan in patients with adenocarcinoma of the small intestine

“…To date, no reports have described SBA patients treated with IP as fi rst-line chemotherapy. Polyzos et al [7] reported that two of three patients with advanced SBA achieved PR and palliation of symptoms with single-agent irinotecan, while Locher et al [6] found that second-line chemotherapy with 5-FU and irinotecan resulted in disease stabilization in 50% of patients. Fishman et al [13] retrospectively reported that a chemotherapy regimen including irinotecan appeared to offer higher overall response rates than fl uorouracil-based regimens for fi rst-or second-line chemotherapy.…”

“…Erlichman et al [14] reported that, in a phase I study, combination treatment with irinotecan, 5-FU, leucovorin, and oxaliplatin resulted in one partial response and two patients with SD. Also, Locher et al [6] found that combining 5-FU and platinum compounds for fi rst-line chemotherapy resulted in an objective response rate of 21%, a median progression-free survival of 8 months, and median overall survival (OS) of 14 months, with manageable toxicities.…”