Systemic anticancer therapy for refractory malignant bowel obstruction in advanced cancer patients: a retrospective cohort study

OBJECTIVES: Malignant bowel obstruction (MBO) is a common but severe complication of advanced cancer. The role of systemic anticancer therapy in patients with inoperable MBO remains poorly defined. This study aimed to assess the efficacy of systemic anticancer therapy in this setting. METHODS: We conducted a retrospective, single-centre cohort study including patients hospitalised for MBO between January 2015 and February 2025 at Tenon University Hospital (Paris, France). Eligible patients had advanced cancer with inoperable MBO refractory to medical management and treated by systemic anticancer therapy. The primary endpoint was the rate of bowel resolution. Secondary endpoints included overall survival (OS), time to resolution, reobstruction rate and treatment-related toxicity. Subgroup analyses were performed according to line of therapy and tumour type. RESULTS: 64 patients were included (median age 62 years; 84% female; 50% Eastern Cooperative Oncology Group Performance Status ≤2). Obstruction resolution occurred in 33% of patients. Median OS was 50 days (95% CI 39 to 83). Among responders, 38% experienced reobstruction (median time 33 days, IQR 24-48). Toxicity was substantial (70% adverse events in all grades; 58% grade ≥3). Patients with gynaecological tumours had improved OS compared with others (66 vs 39 days; HR 1.66; p=0.046). In this subgroup, first-line therapy was associated with higher resolution rates (OR 8.67; p=0.019). CONCLUSIONS: In inoperable MBO, anticancer therapy achieved obstruction resolution in one-third of patients but was associated with substantial toxicity and limited survival. Careful patient selection and early goals-of-care discussions are essential. Prospective studies incorporating quality-of-life outcomes are needed.