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Chemotherapy for patients with unresectable or metastatic small bowel adenocarcinoma: a systematic review

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International Journal of Clinical Oncology Aims and scope Submit manuscript

Abstract

Background

There is no standard chemotherapy available for unresectable or metastatic small bowel adenocarcinoma (SBA) because of its rarity. This systematic review aims to assess the efficacy and safety of chemotherapy for patients with unresectable or metastatic SBA.

Methods

In accordance with the PRISMA statements, literature search was conducted using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. The included studies were prospective randomized, nonrandomized, or observational studies. Risk of bias was assessed the ROBINS-I tool.

Results

Seven prospective single-arm Phase II studies were included in this review. Six of them were assessed as having a moderate risk of bias and one as having a serious risk of bias. A meta-analysis was not performed, because the studies were single-arm. Systemic chemotherapy based on fluoropyrimidine regimens achieved favorable outcomes with acceptable adverse effects as a first therapy; however, the regimens differed in each study. The object response rate was 18–50%, and the disease control rate was 29–87%. With 5-fluorouracil, adriamycin, and mitomycin-C regimen, one treatment-related death occurred. A second line of therapy including chemotherapy with nab-paclitaxel also showed favorable efficacy. The object response rate was 20%, and the disease control rate was 50%.

Conclusions

Systemic chemotherapy based on fluoropyrimidine regimens was mainly used for unresectable or metastatic SBA. While it may achieve favorable outcomes with acceptable adverse effects, further evidence is needed.

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Acknowledgements

YN was supported by Japan Society for the Promotion of Science.

Funding

This work was not supported by a specific funding.

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Authors and Affiliations

  1. Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Yoshitaka Nishikawa, Takahiro Horimatsu, Taro Funakoshi & Manabu Muto

  2. Department of Health Informatics, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan

    Yoshitaka Nishikawa, Nobuaki Hoshino & Takeo Nakayama

  3. Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Nobuaki Hoshino, Koya Hida & Yoshiharu Sakai

Authors
  1. Yoshitaka Nishikawa
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  2. Nobuaki Hoshino
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  3. Takahiro Horimatsu
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  4. Taro Funakoshi
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  8. Takeo Nakayama
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Contributions

YN, NH, TH: Conception and design; YN, NH: Literature search and data analysis; all authors: Interpretation of the results; YN: Drafting of the article; all authors: Critical revision of the article f; all authors: Final approval of the article.

Corresponding author

Correspondence to Yoshitaka Nishikawa.

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Conflict of interest

MM received research funding outside the submitted work from TAIHO PHARMACEUTICAL CO., LTD., Nissha Co., Ltd., KUBIX Inc., SYSMEX CORPORATION, Thyas Co., Ltd., ONO PHARMACEUTICAL CO., LTD., ACTmed Co., LTD., Eisai Co., Ltd., RIKEN GENESIS CO., LTD., CHUGAI PHARMACEUTICAL CO., LTD., Bio-xcelerator K.K., Gtheranostics Co., Ltd., Yakult Honsha Co., Ltd., IQVIA Services Japan K.K., Parexel International Inc., MSD K.K., and Meiji Seika Pharma Co., Ltd; and scholarship donation outside the submitted work from ARK INNOVATION Inc., ONO PHARMACEUTICAL CO., LTD, AYUMI Pharmaceutical Corporation, Showa Yakuhin Kako Co.,Ltd., CHUGAI PHARMACEUTICAL CO., LTD., INTAGE Healthcare Inc., Cyber Laboratory Inc., Gtheranostics Co., Ltd., and Yakult Honsha Co.,Ltd. TN received honoraria outside the submitted work from ONO PHARMACEUTICAL CO., LTD., Nippon Boehringer Ingelheim Co., Ltd., and Pfizer Japan Inc. YN, NH, TH, TF, KH, and YS declare no conflict of interest.

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Nishikawa, Y., Hoshino, N., Horimatsu, T. et al. Chemotherapy for patients with unresectable or metastatic small bowel adenocarcinoma: a systematic review. Int J Clin Oncol 25, 1441–1449 (2020). https://doi.org/10.1007/s10147-020-01703-z

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  • DOI: https://doi.org/10.1007/s10147-020-01703-z

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