Advances in Small Bowel Cancer Generate New NCCN Guidelines

Tony Berberabe, MPH @OncBiz_Wiz
Published: Sunday, Oct 20, 2019
Katrina S. Pedersen,
MD, MS

Katrina S. Pedersen, MD, MS

A new set of recommendations for the treatment of small bowel adenocarcinoma (SBA), a relatively rare type cancer of the gastrointestinal (GI) tract, have been created by the National Comprehensive Cancer Network (NCCN). The guidelines are the first in the United States and second in the world to recommend treatments specific to the malignancy, which is often diagnosed at advanced stages.

Table. NCCN Adjuvant Therapy Recommendations for SBA1 (Click to Enlarge)

The NCCN recommendations for adjuvant therapy include the following: 6 months of FOLFOX, CAPEOX, 5-FU/LV, or capecitabine for any locally advanced SBA with positive lymph nodes (stage III); observation or 6 months of FOLFOX, CAPEOX, 5-FU/ LV, or capecitabine for stage II tumors that are microsatellite stable (MSS) or MMR proficient (pMMR) and have high-risk features, including T4 stage, close or positive surgical margins, few lymph nodes examined, or tumor perforation; observation or 6 months of 5-FU/ LV or capecitabine for T3, N0, M0 (stage IIA) tumors that are MSS or pMMR; and observation following surgery for all stage I tumors and stage II tumors that are MSI high.1

Immunotherapy: ZEBRA Trial

Pedersen also highlighted findings from the ZEBRA trial,4 in which pembrolizumab (Keytruda) failed to achieve the target response rate in pretreated patients with SBA but did control disease in some patients with MSS tumors. She noted that the data have not been formally reviewed by the NCCN committee yet, as the guidelines were finalized prior to the trial’s data embargo being lifted. Findings were presented during the European Society for Medical Oncology 21st World Congress on Gastrointestinal Cancer, held July 3 to 6, 2019, in Barcelona, Spain.4

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