Cetuximab in small bowel adenocarcinoma: a new friend?

Small bowel adenocarcinoma (SBA) is a rare and aggressive tumour. SBA in the United States increased from 5.7 cases per million in 1973 to 7.3 cases per million in 2004 (Surveillance Epidemiology and End Results (SEER), 1973–2004 database; Jemal et al (2009 ). Surgery is the mainstay of treatment, even if chemotherapy in advanced disease has been associated with an increased survival. The most effective agents include 5-FU, irinotecan, platinum agents and gemcitabine ( Fishman et al, 2006 ; Speranza et al, 2010 ). The molecular characterisation of this cancer could help to improve prognosis. Specifically, the frequency of KRAS gene mutations is similar than in colorectal cancer ( Ari et al, 1997 ). The role of targeted therapy, specifically of epidermal growth factor receptor (EGFR) inhibitors, has never been investigated in patients with SBA. A recent report showed that a high percentage of tumours express both EGFR and VEGF-A suggesting that these patients could benefit from therapeutic strategies targeting EGFR and VEGF receptors ( Overman et al, 2010 ).