Efficacy of recent chemotherapy regimen in advanced small bowel carcinoma

Abstract

15112 Background: Small bowel carcinoma (SBC) is a rare tumour. Very few data concerning the chemotherapy efficacy are published. The overall survivals previously reported were 8 to 14 months. The aim of the study was to evaluate the efficacy of recent chemotherapy regimen in advanced SBC. Methods: All the consecutive patients treated recently by first line chemotherapy for advanced SBC were included retrospectively in a multicentric study. Clinical and radiological evaluations were performed every 2 or 3 months according to WHO criteria. Chemotherapy was stopped in case of progression, severe toxicity or patient willing. Results: Fifty seven patients (33 men, 24 women), median age 56 years [32–83] treated from 1994 to 2006 in 10 institutions were included. Primary tumours were: duodenum n=35 (61%), jejunum n=14 (25%) and ileum n=8 (14%). Three patients had Crohn disease and one HNPCC syndrome. The tumour were locally advanced in 6 patients (10%), or with metastasis in 51 (90%), synchronous n=35 or metachronous n=16. The mains metastasis sites were peritoneal carcinomatosis in 29, liver in 19 and nodes in 13 patients. Sixteen patients have had an initial R0 surgery and 8 had received, before inclusion, adjuvant chemotherapy. The regimens used in first line were: FOLFOX n=21 (37%), LV5FU2-cisplatine n=13 (23%), LV5FU2 n=12 (21%), FOLFIRI n=10 (17%). Twenty five (44%) patients have had grade 3 or 4 toxicity. A toxic death occurred after a cure of FOLFOX. Chemotherapy was stopped in relation to toxicity in 7 (12%) patients. A dose reduction was done in 15 (26%) patients for a total of 16% of the cures. Tumor was measurable in 42 (73%) pts. A partial response was observed in 13 patients (31%), stabilisation in 14 (33%) and progression in 15 (36%). Thirty six (63%) pts had a second line chemotherapy. Time to treatment failure was 6 [1–21] months in all patients and 7 [2–19], 7 [2–20], 5 [1–21] and 4 [1–10] months according to treatment by FOLFOX, LV5FU2, FOLFIRI or LV5FU2-cisplatine respectively. Overall survival was 11 months [1–36]. Overall survival according to the primary localization were: duodenum: 9 [1–34], jejunum: 18 [3–32], ileum: 15 [4- 36]. Conclusions: Advanced SBC have a bad prognosis. The chemotherapy regimen used in colon cancer did not reach the same efficacy in SBC. No significant financial relationships to disclose.