Symons Rebecca, Daly Daniel, Gandy Robert, Goldstein David, Aghmesheh Morteza
Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, High St, Randwick, Sydney, NSW, 2031, Australia.
University of New South Wales, Randwick, NSW, Australia.
Curr Treat Options Oncol. 2023 Apr;24(4):241-261. doi: 10.1007/s11864-023-01058-3. Epub 2023 Feb 24.
Small intestine cancer is rare, accounting for approximately 3% of all gastrointestinal malignancies. The most common histological subtypes include adenocarcinoma, neuroendocrine tumours (NETs) and gastrointestinal stromal tumours (GISTs). In localised disease, surgery remains the mainstay of treatment and the best approach to improve survival. Current treatment for small intestine adenocarcinoma (SIA) is extrapolated from small studies and data from colorectal cancer (CRC). There is limited evidence to guide therapy in the adjuvant setting. However, there are small phase II studies in the advanced setting providing evidence for the role of chemotherapy and immunotherapy. There is also limited evidence assessing the efficacy of targeted therapies. Small intestine NETs are rare, with evidence for somatostatin analogue therapy, particularly in the low to intermediate-grade well-differentiated tumours. Poorly differentiated NETs are generally managed with chemotherapy but have worse outcomes compared with well-differentiated NETs. The management of small intestine GISTs is largely targeting KIT mutations with imatinib. Recent trials have provided evidence for effective therapies in imatinib-resistant tumours and the potential role of immunotherapy. The aim of this article was to review the evidence for the current management and recent advances in the management of small intestine adenocarcinoma, NETs and GISTs.
小肠癌较为罕见，约占所有胃肠道恶性肿瘤的3%。最常见的组织学亚型包括腺癌、神经内分泌肿瘤（NETs）和胃肠道间质瘤（GISTs）。对于局限性疾病，手术仍然是主要的治疗方法，也是提高生存率的最佳途径。目前小肠腺癌（SIA）的治疗方法是从小型研究以及结直肠癌（CRC）的数据推断而来的。在辅助治疗方面，指导治疗的证据有限。然而，在晚期阶段有一些小型II期研究为化疗和免疫治疗的作用提供了证据。评估靶向治疗疗效的证据也很有限。小肠NETs很罕见，有证据支持生长抑素类似物治疗，特别是对于低至中级分化良好的肿瘤。分化差的NETs一般采用化疗，但与分化良好的NETs相比，预后更差。小肠GISTs的治疗主要针对KIT突变使用伊马替尼。最近的试验为伊马替尼耐药肿瘤的有效治疗方法以及免疫治疗的潜在作用提供了证据。本文的目的是综述小肠腺癌、NETs和GISTs当前治疗方法的证据以及治疗方面的最新进展。
