e15726 Background: Small bowel cancers (SBC) are rare malignancies accounting for < 5% of gastrointestinal (GI) cancers. Data on real-world epidemiology, molecular profiles, and treatment outcomes remain limited. We aimed to characterize the clinicopathologic features, treatment patterns, and survival outcomes of patients (pts) with SBC treated at a single tertiary cancer center. Methods: We conducted a retrospective cohort study of adult pts diagnosed with SBC at the American University of Beirut Medical Center between 2016 and 2024. Clinical, pathological, and molecular data were extracted from electronic medical records, including tumor location, histology, stage, systemic therapies, and outcomes. Results: A total of 1,118 pts diagnosed with GI cancers were reviewed, of whom 36 pts (3.2%) were diagnosed with SBC. Median age at diagnosis was 59 years (range 25-85), and 58.3% were males. Histologies included adenocarcinoma (44.4%), neuroendocrine tumors (NET) (27.8%), and GIST (27.8%). The most common primary site was duodenum (44%). At diagnosis, 23 pts (64%) had metastatic disease, 91% of whom had liver metastasis. 26 pts underwent surgical resection. Patterns of systemic therapy for pts who received it are shown in table 1. Molecular profiling was mostly performed for adenocarcinoma histology (4/16 (25%)). Among 8 biopsies tested by IHC, 100% were MSS. Among GIST cases, 2 patients underwent genomic testing, both harboring KIT exon 9 alterations. NET tumors were predominantly low–intermediate grade (grade 1: 30%; grade 2: 70%), with Ki-67 ranging from < 3% to 15%. Overall survival at 1, 2, 5 and 7 years was 100%, 95%, 88% and 70% respectively. Conclusions: In this real-world cohort, most patients presented with advanced disease and near-universal hepatic tropism with liver involvement in most metastatic cases. Multimodality management with histology-directed systemic was widely implemented, integrating surgical resection with subtype-specific therapies. Although survival outcomes showed a high proportion of patients alive at follow-up, SBC continue to require improved early detection and broader molecular characterization. Further studies are warranted to better define disease-specific prognostic and genomic determinants to support personalized treatment strategies and improve long-term outcomes in SBC. Summary of systemic therapies by histology. Histology First-line Second-line Third-line Adenocarcinoma (n=13) Combination 5-FU +/- oxaliplatin or irinotecan (61.5%)5-FU based chemotherapy regimen + targeted therapies (30.8%)Capecitabine (7.7%) Gemcitabine +cisplatin (7.7%) - NET (n=10) Lanreotide (20%)Octreotide (10%)Lu 177 (10%) Everolimus (10%)Capecitabine (10%) - GIST (n=10) Imatinib (100%) Sunitinib (30%) Regorafenib (20%)
Mahmasani et al. (Thu,) studied this question.
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