Evolving pharmacotherapeutic strategies for small bowel adenocarcinoma

Importance of the field: Owing to nonspecific signs and symptoms, the majority of patients with small bowel adenocarcinoma (SBA) present with advanced-stage disease. Few studies in the literature adequately address the role of chemotherapy in SBA. The regimens used in colon and gastric cancers have been tried in SBA with varying degrees of success. Areas covered in this review: The authors explore the natural history and diagnostic evaluation of SBA, followed by a focused review of existing studies on individual agents and combinations used in the therapy of this malignancy. What the reader will gain: 5-fluorouracil-based chemotherapy seems to offer a clinical benefit in advanced SBA. The reader will acquire considerable insights about the most effective chemotherapy drugs and combination regimens used in advanced SBA. Take home message: Given the rarity of this malignancy, multicenter, randomized clinical trials are essential in the design of optimal therapeutic strategies for SBA. The role of adjuvant therapy in SBA remains to be clarified. Prospective evaluation of new agents and their incorporation into various therapeutic schemes for advanced/metastatic disease is also necessary. Until then, therapeutic decisions should be individualized and based on the benefits and toxicities of the most effective drugs or combinations.