Systemic Treatments for Advanced Small Bowel Adenocarcinoma: A Systematic Review

SIMPLE SUMMARY: Small bowel adenocarcinoma is a rare disease that is usually treated following the protocols in use for colorectal cancer. The aim of this systematic review was to identify the optimal treatment for this disease according to the currently available evidence. We concluded that there is some evidence regarding the use of chemotherapy doublets in this setting, but not to support the use of biological agents. There are encouraging results regarding the use of immunotherapy in selected patients. ABSTRACT: Small bowel adenocarcinoma (SBA) is a rare disease for which scarce evidence is available. We summarized data available on systemic treatment of advanced SBA. Methods: Scientific literature was evaluated to find phase II or phase III clinical trials on systemic treatment for advanced SBA. MeSH terms were selected and combined for the initial search, then inclusion and exclusion criteria were set in a search protocol. Four medical oncologists looked for evidence on Medline, EMBASE and Cochrane databases. Moreover, abstracts from 2016 to June 2021 from the American Society for Clinical Oncology, European Society for Medical Oncology, Gastrointestinal Cancer Symposium and World Congress on Gastrointestinal Cancer were browsed. The selected studies, matching the inclusion and exclusion criteria, were finally tabulated and analyzed. Results: The trials finally selected were 18 phase II/III clinical trials. Four small phase II trials support the activity of oxaliplatin-based doublets in first-line treatment (CAPOX and mFOLFOX). Conclusion: No good level evidence is available on the use of bevacizumab, anti-epidermal growth factor receptor, targeted agents or immunotherapy. First-line treatments are largely derived from colorectal cancer protocols, mainly oxaliplatin-based doublets.