Small Bowel Adenocarcinoma — SCE Medical Oncology MCQ

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ModerateGI CancersSmall Bowel AdenocarcinomaSCE Medical Oncology

A 62-year-old man with small bowel adenocarcinoma (a rare GI cancer) is starting first-line chemotherapy. No targeted therapy is standard. What chemotherapy regimen is generally used, extrapolated from colorectal cancer evidence?

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Correct answer: E — FOLFOX or CAPOX

Small bowel adenocarcinoma is rare, and there are limited dedicated RCT data. Treatment is extrapolated from colorectal cancer guidelines, with FOLFOX or CAPOX as the standard first-line regimen. The BALLAD trial (adjuvant) and retrospective series support oxaliplatin-based doublets. MSI-H status should be checked (occurs in approximately 15% of small bowel adenocarcinomas, especially duodenal), as these patients may benefit from immunotherapy. Molecular profiling is increasingly important.

Reference: ESMO 2024 Small Bowel Adenocarcinoma Guidelines; Overman et al JCO 2010