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Clinical outcome of salvage chemotherapy after oxaliplatin based chemotherapy for metastatic small bowel adenocarcinoma

Abstract Background Although palliative chemotherapy (CTx) for metastatic small bowel adenocarcinoma (mSBA) has not been established, fluoropyrimidine plus oxaliplatin (FOx) is globally accepted as a standard CTx based on several studies. While CTx for colorectal cancer has been recommended in NCCN guidelines, limited efficacy of irinotecan (IRI) and panitumumab for mSBA had also been shown in western countries. Thus, there has been no salvage line chemotherapy (SLC) which can be recommended for mSBA after failure to FOx. The aim of this study was to provide the information of clinical outcomes of SLC for mSBA after failure of FOx. Methods mSBA patients (pts) who received SLC after failure of FOx from 2010 to 2019 in our institute were retrospectively analyzed. Pts who received 1st line CTx other than FOx, ongoing FOx, or with insufficient follow-up were excluded. Results Of 59 mSBA pts, eligible 33 were extracted from our database. Age (median): 58 year-old, PS (0/1/>=2): 3/21/9, primary site (duodenum/jejunum and ileum): 13/20, stage (IV/recurrence): 23/10. Metastatic sites were peritoneum in 25 (75.8%) pts, and liver in 12 (36.4%). Twenty-two (66.7%) pts received SLC, pts with good PS (0-1) tended to receive SLC. As 2nd line CTx, 16 of 22 pts (72.7%) received IRI-based CTx and gemcitabine (GEM) in 3. Eight of 22 pts received 3rd line CTx; nab-paclitaxel (off-label use for APC-wild type) in 4, and GEM in 2. MST in all pts was 4.5 months, which was longer in pts treated with SLC than those with best supportive care (5.7 vs 1.7 months, p  Conclusion Limited efficacy of SLC for mSBA was shown also in Japanese population. This is very important baseline data to lead to the future drug development.