Chemotherapy of advanced small-bowel adenocarcinoma: a multicenter AGEO study.
BACKGROUND
Small-bowel adenocarcinoma (SBA) is a rare tumor of poor prognosis. Data on the efficacy of chemotherapy for advanced SBA are scarce.


METHODS
All patients with advanced SBA who received frontline chemotherapy from 1996 to 2008 were eligible for this retrospective multicenter study.


RESULTS
Ninety-three consecutive patients were included. In the entire population, the median progression-free survival (PFS) and overall survival (OS) times were 6.6 and 15.1 months, respectively. Median PFS times among patients treated with LV5FU2 (n = 10), FOLFOX (n = 48), FOLFIRI (n = 19) and LV5FU2-cisplatin (n = 16) were 7.7, 6.9, 6.0 and 4.8 months, respectively, while median OS times were 13.5, 17.8, 10.6 and 9.3 months, respectively. In multivariate analysis, World Health Organization performance status (PS) (P < 0.0001) and elevated serum levels of carcinoembryonic antigen (CEA) (P = 0.02) and carbohydrate antigen 19-9 (CA 19-9) (P = 0.03) were the only variables significantly associated with poor OS. In the subgroup of patients treated with platinum-based chemotherapy, multivariate analysis showed that LV5FU2-cisplatin was associated with poorer PFS (P < 0.0001) and OS (P = 0.02) compared with FOLFOX.


CONCLUSIONS
This is the largest study of chemotherapy in advanced SBA. Baseline PS and CEA and CA 19-9 levels were the main prognostic factors. FOLFOX seems to be the most effective platinum-based chemotherapy regimen.
Zaanan
A
A
Department of Medical Oncology, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, University Paris VI.
Costes
L
L
Department of Medicine, Institut Gustave Roussy, University Paris Sud, Villejuif.
Gauthier
M
M
Biostatistics and Epidemiological Unit, Georges François Leclerc Center, Dijon.
Malka
D
D
Department of Medicine, Institut Gustave Roussy, University Paris Sud, Villejuif.
Locher
C
C
Department of Hepato-Gastroenterology, Meaux Hospital, Meaux.
Mitry
E
E
Department of Hepatogastroenterology and Digestive Oncology, Ambroise Paré Hospital, Assistance Publique Hôpitaux de Paris, Boulogne-Billancourt.
Tougeron
D
D
Department of Hepatogastroenterology, Charles Nicolle Hospital, Rouen.
Lecomte
T
T
Department of Hepatogastroenterology, Trousseau Hospital, University François Rabelais, Tours.
Gornet
J-M
JM
Department of Hepatogastroenterology, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris.
Sobhani
I
I
Department of Hepatogastroenterology, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil.
Moulin
V
V
Department of Medical Oncology, Louis Pasteur Hospital, Coudray.
Afchain
P
P
Department of Medical Oncology, Saint-Antoine Hospital, Assistance Publique Hôpitaux de Paris, University Paris VI.
Taïeb
J
J
Department of Hepatogastroenterology, Européen Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris.
Bonnetain
F
F
Biostatistics and Epidemiological Unit, Georges François Leclerc Center, Dijon.
Aparicio
T
T
Department of Gastroenterology, Avicenne Hospital, Assistance Publique Hôpitaux de Paris, University Paris XIII, Bobigny, France and AGEO (Association des Gastroente'rologues Oncologues/Gastroenterologists Oncologists Association). Electronic address: thomas.aparicio@avc.aphp.fr.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D002945:Cisplatin / Q000008:administration & dosage; D004379:Duodenal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007078:Ileal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D007421:Intestine, Small / Q000187:drug effects / Q000473:pathology; D000077146:Irinotecan; D007580:Jejunal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002955:Leucovorin / Q000008:administration & dosage; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D000077150:Oxaliplatin; D010534:Peritoneal Neoplasms / Q000188:drug therapy* / Q000556:secondary; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D000077146:Irinotecan; D002945:Cisplatin; D002955:Leucovorin; D005472:Fluorouracil; D002166:Camptothecin