Management of Adenocarcinoma of the Small Intestine

In this issue of GCR , Overman provides a comprehensive overview of develop ments in adjuvant and palliative chemotherapy in small bowel adenocarcinoma (SBA) . 1 This rare disease is associated with no specific symptoms and is not often thought about in the differential diagnosis of common gastrointestinal presentations. As a result, SBA is often diagnosed at a late stage, and only 50% of patients undergo surgery with curative intent. Therefore, the prognosis is considerably worse than for colorectal cancer. Overman clearly argues on the basis of the pattern of disease progression (systemic relapse) that adjuvant chemotherapy should be useful in the management of patients undergoing surgery for SBA. To date, however, the evidence for routine use of adjuvant chemotherapy is lacking. Most centers have used single-agent 5-fluorouracil (5-FU). In contrast, for patients with advanced SBA, there is evidence of beneficial effects (response rate and survival) from prospec tive and retrospective studies using 5-FU in combination with platinum agents, and retrospective evidence exists for the use of irinotecan ± 5-FU. Overman has concluded that the combination of capecitabine and oxaliplatin is the optimal chemotherapy approach for patients with advanced SBA on the basis of a response rate of 60% and a median overall survival of 20 months . 2