Palliative chemotherapy for patients with synchronous metastases of small‐bowel adenocarcinoma: A reflection of daily practice

Legué, Laura M.; Bernards, Nienke; Lemmens, Valery; Hingh, Ignace H. J. T. de; Creemers, Geert-Jan; Erning, Felice N. van

doi:10.1177/2050640619858211

Cited by 4 publications

(8 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…After full-text revision, 57 studies were included, with a total of 35 176 patients. Among the 57 studies, 6 studies 27 , 28 , 29 , 30 , 31 , 32 were prospective cohort studies or phase 2 trials, and 51 studies 1 , 3 , 4 , 17 , 19 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 were retrospective in nature ( Table ; eTables 1 and 2 in…”

Section: Resultsmentioning

confidence: 99%

“…Of 57 studies, 23 studies 3 , 17 , 27 , 29 , 30 , 31 , 32 , 33 , 36 , 38 , 44 , 49 , 50 , 51 , 58 , 60 , 62 , 63 , 70 , 71 , 73 , 74 , 77 (40.4%) were subject to serious risk of bias due to the lack of multivariable analyses and selection bias (eTable 3 in Supplement 1 ). Thirty-three studies 1 , 4 , 19 , 28 , 34 , 35 , 37 , 39 , 40 , 41 , 42 , 43 , 45 , 46 , 47 , 48 , 52 , 53 , 54 , 55 , 56 , 57 , 59 , 61 , 64 , 65 , 66 , 67 , 69 , 72 , 75 , 76 , 78 (57.9%) had medium or low risk of bias. For 1 study, 68 risk of bi...…”

Section: Resultsmentioning

confidence: 99%

“…Our meta-analysis is affected by several limitations. Unfortunately, most studies 1 , 3 , 4 , 17 , 19 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 were nonrandomized cohort studies. Hence, the outcomes of some of our meta-analyses are subject to selection bias and confounding by prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

“…After first-line chemotherapy, the mOS was 14.5 (95% CI, 13.5-15.5) months and the mPFS was 6.7 (95% CI, 6.0-7.4) months, decreasing to an mOS of 8.6 (95% CI, 6.9-10.4) months in the third line (Figure 4). In nonpooled studies, 1,3,19,59,62,66,71,72 the mOS after first-line chemotherapy ranged from 6.8 to 22.2 months vs 2.0 to 12.0 months for untreated patients. In line with our previous metaanalyses, the mPFS was best after FOLFOX therapy (8.2 months; 95% CI, 7.0-9.3 months) and fluoropyrimidine-oxaliplatin therapy (including CAPOX) (7.5 months; 95% CI, 6.0-9.0 months).…”

Section: Jama Network Open | Oncologymentioning

confidence: 99%

See 3 more Smart Citations

Evaluation of Systemic Treatments of Small Intestinal Adenocarcinomas

et al. 2023

View full text Add to dashboard Cite

ImportanceAlthough small intestinal adenocarcinomas (SIAs) are rare, they have a poor prognosis, and the optimal treatment strategies are largely unknown. Because of the lack of high-quality evidence, guidelines for colorectal cancer are often followed in the treatment of SIAs.ObjectiveTo review the current evidence regarding survival benefit of systemic therapies, including chemotherapy, targeted agents, and immunotherapy, for patients with SIAs.Data SourcesFollowing the Preferred Reporting Items for Systematic Reviews and Meta-analyses, MEDLINE and Embase were searched for articles published from January 1, 2005, until June 1, 2022.Study SelectionRetrospective cohort studies and prospective phase 2 or 3 trials describing survival after systemic therapies for patients with SIAs were eligible for inclusion. Assessment of study eligibility was blinded and performed by 3 reviewers.Data Extraction and SynthesisThe reviewers independently extracted data. Random effects, inverse variance, pairwise meta-analyses were performed.Main Outcomes and MeasuresPrimary outcomes were overall survival (OS) and progression-free survival (PFS) of patients with SIAs after systemic therapies. Measures of interest included hazard ratios for survival and median survival times.ResultsOverall, 57 retrospective cohort and phase 2 studies of 35 176 patients were included. Adjuvant chemotherapy, generally fluoropyrimidine-based, was associated with increased OS in stage I to III SIAs (hazard ratio [HR], 0.60; 95% CI, 0.53-0.68), especially in stage III tumors (HR, 0.55; 95% CI, 0.48-0.64), irrespective of tumor localization. Palliative chemotherapy was also associated with an OS benefit (HR, 0.48; 95% CI, 0.40-0.58). Fluoropyrimidine-oxaliplatin combinations were superior to other regimens (OS: HR, 0.54; 95% CI, 0.30-0.99; PFS: HR, 0.46; 95% CI, 0.30-0.71). Furthermore, bevacizumab added to chemotherapy compared with chemotherapy alone was associated with significantly prolonged PFS (HR, 0.62; 95% CI, 0.43-0.89). Immunotherapy showed a 50% overall response rate in previously treated defective mismatch repair tumors.Conclusions and RelevanceIn this systematic review and meta-analysis, adjuvant and palliative chemotherapy were both associated with improved survival of patients with SIAs, especially fluoropyrimidine-based regimens and fluoropyrimidine-oxaliplatin combinations. Adding bevacizumab to chemotherapy appears to prolong PFS and deserves further investigation. Immunotherapy seems beneficial and should be considered for patients with defective mismatch repair tumors. International collaborations should be undertaken to confirm and improve efficacy of systemic therapies for patients with SIAs.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Jama Network Open | Oncologymentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of Systemic Treatments of Small Intestinal Adenocarcinomas

et al. 2023

View full text Add to dashboard Cite

show abstract

“…A systematic review of seven prospective studies revealed that adjuvant chemotherapy was effective for unresectable or metastatic SBA ( 34 ). In a retrospective analysis of patients with metastatic SBA, patients who received palliative chemotherapy had a median OS of 9.3 months, significantly better than those who did not receive chemotherapy ( 35 ). These studies suggested that adjuvant chemotherapy had a certain benefit in improving the prognosis of metastatic SBA.…”

Section: Discussionmentioning

confidence: 99%

Metastasis Pattern and Survival Analysis in Primary Small Bowel Adenocarcinoma: A SEER-Based Study

Deng

Wang

et al. 2021

Front. Surg.

View full text Add to dashboard Cite

Background: Small bowel adenocarcinoma (SBA) is a rare gastrointestinal tumor with high malignancy. The aim of this study was to comprehensively evaluate the distant metastasis pattern and establish nomograms predicting survival for SBA.Methods: From 2010 to 2015, patients diagnosed with SBA were identified based on the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan–Meier survival analysis was applied to compare survival differences between metastasis patterns. Then, univariate and multivariate cox analyses were applied to screened out independent prognostic factors of cancer-specific survival (CSS) and overall survival (OS), and identify the risk factors for metastasis of SBA. To assess the discrimination and calibration of nomograms, the concordance index (C-index), calibration curves, receiver-operating characteristic curve (ROC), and decision curve analysis (DCA) were calculated.Results: Kaplan–Meier curves revealed that metastasis patterns were significantly correlated with CSS (p < 0.001) and OS (p < 0.001). Then, the metastasis pattern was showed to be an independent prognostic factor of OS and CSS in patients with SBA, as well as age, grade, T stage, N stage, surgery, retrieval of regional lymph nodes, and chemotherapy. Combining these factors, we constructed prognostic nomograms, which suggested that the metastasis pattern made the greatest contribution to the survival of patients with SBA. Nomograms for OS and CSS had a C-index of 0.787 and 0.793, respectively. Calibration curves showed an excellent agreement between probability and actual observation in the training and validation cohort. Decision curve analysis also exhibited its clinical value with an improved net benefit. In addition, the models we constructed had better prognostic accuracy and clinical utility than traditional TNM staging based on C-index and ROC. Further, Cox regression analysis showed that old age, poor differentiation, N2, and not receiving chemotherapy were the risk factors for prognosis in patients with metastatic SBA.Conclusion: As an independent prognostic factor, the metastasis pattern exhibited the greatest predictive effect on OS and CSS for patients with SBA. Adjuvant chemotherapy had a positive effect on the survival of patients with SBA. Nomograms for predicting 3-and 5-year OS and CSS of patients with SBA were constructed, which could identify patients with higher risk and might be superior in predicting the survival of patients with SBA than TNM staging.

show abstract

Small intestinal metastasis from primary breast cancer: a case report and review of literature

Shen,

Wang,

et al. 2024

Front. Immunol.

View full text Add to dashboard Cite

Small intestinal metastasis from primary breast cancer remains a rare clinical occurrence. Despite extensive research into its clinicopathological features and treatment options, the specific pathogenesis and optimal management strategies remain incompletely understood. This case report presents a patient with breast cancer that metastasized to the small intestine. The primary breast tumor was diagnosed as classic invasive lobular carcinoma. Subsequent surgical intervention successfully addressed the intestinal obstruction and confirmed the metastatic origin of the small intestinal tumor. Interestingly, the metastatic lesions exhibited features suggestive of pleomorphic lobular carcinoma. A PET-CT scan was performed to evaluate the distant metastasis status of this patient. Notably, hormonal receptor status shifted from positive to negative, while HER2 expression changed from negative to low between the primary tumor and metastatic lesions. The presence of an undiagnosed pleomorphic component in the primary tumor might explain the disease’s progressive nature. In this case, systemic treatment with trastuzumab deruxtecan yielded favorable therapeutic outcomes. Overall, our findings suggest that re-evaluation of receptor status in breast cancer metastases is crucial for tailoring treatment strategies. Furthermore, a combination of palliative resection of small intestinal metastases and targeted therapy for HER2-low breast cancer may potentially improve survival.

show abstract

Palliative chemotherapy for patients with synchronous metastases of small‐bowel adenocarcinoma: A reflection of daily practice

Cited by 4 publications

References 32 publications

Evaluation of Systemic Treatments of Small Intestinal Adenocarcinomas

Evaluation of Systemic Treatments of Small Intestinal Adenocarcinomas

Metastasis Pattern and Survival Analysis in Primary Small Bowel Adenocarcinoma: A SEER-Based Study

Small intestinal metastasis from primary breast cancer: a case report and review of literature

Contact Info

Product

Resources

About