Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Health Informatics, Kyoto University School of Public Health, Yoshida-Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.
Int J Clin Oncol. 2020 Aug;25(8):1441-1449. doi: 10.1007/s10147-020-01703-z. Epub 2020 May 24.
There is no standard chemotherapy available for unresectable or metastatic small bowel adenocarcinoma (SBA) because of its rarity. This systematic review aims to assess the efficacy and safety of chemotherapy for patients with unresectable or metastatic SBA.
In accordance with the PRISMA statements, literature search was conducted using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials. The included studies were prospective randomized, nonrandomized, or observational studies. Risk of bias was assessed the ROBINS-I tool.
Seven prospective single-arm Phase II studies were included in this review. Six of them were assessed as having a moderate risk of bias and one as having a serious risk of bias. A meta-analysis was not performed, because the studies were single-arm. Systemic chemotherapy based on fluoropyrimidine regimens achieved favorable outcomes with acceptable adverse effects as a first therapy; however, the regimens differed in each study. The object response rate was 18-50%, and the disease control rate was 29-87%. With 5-fluorouracil, adriamycin, and mitomycin-C regimen, one treatment-related death occurred. A second line of therapy including chemotherapy with nab-paclitaxel also showed favorable efficacy. The object response rate was 20%, and the disease control rate was 50%.
Systemic chemotherapy based on fluoropyrimidine regimens was mainly used for unresectable or metastatic SBA. While it may achieve favorable outcomes with acceptable adverse effects, further evidence is needed.
由于小肠腺癌（SBA）罕见，因此对于不可切除或转移性 SBA 尚无标准的化疗方案。本系统评价旨在评估化疗对不可切除或转移性 SBA 患者的疗效和安全性。
根据 PRISMA 声明，使用 PubMed、Scopus 和 Cochrane 对照试验中心注册库进行文献检索。纳入的研究为前瞻性随机、非随机或观察性研究。使用 ROBINS-I 工具评估偏倚风险。
本综述纳入了 7 项前瞻性单臂 II 期研究。其中 6 项研究被评估为具有中度偏倚风险，1 项研究具有严重偏倚风险。由于这些研究均为单臂研究，因此未进行荟萃分析。以氟嘧啶为基础的全身化疗方案作为一线治疗具有良好的疗效和可接受的不良反应，但各研究中方案不同。客观缓解率为 18%-50%，疾病控制率为 29%-87%。氟尿嘧啶、阿霉素和丝裂霉素 C 方案中，有 1 例与治疗相关的死亡。二线化疗方案中包括nab-紫杉醇联合化疗也显示出良好的疗效。客观缓解率为 20%，疾病控制率为 50%。
以氟嘧啶为基础的全身化疗方案主要用于不可切除或转移性 SBA。虽然它可能具有良好的疗效和可接受的不良反应，但仍需要更多证据。
