Skip to main content
Top
Published in: Clinical Journal of Gastroenterology 3/2020

01-06-2020 | Computed Tomography | Case Report

A case of small bowel adenocarcinoma wherein nivolumab conferred temporary benefit in disease control

Authors: Kazutaka Iijima, Mitsuharu Oozeki, Kaori Ikeda, Hiroyuki Honda, Hajime Ishibashi, Masaharu Yamaoka, Shinji Fujieda, Hitoaki Saitoh, Mitsuhide Goto, Masahiro Araki, Kenji Amagai

Published in: Clinical Journal of Gastroenterology | Issue 3/2020

Login to get access

Abstract

Small bowel adenocarcinomas are rare. There is no definite consensus as to whether they should be treated in a manner similar to gastric or to colon cancer. We report the case of a young woman with a primary jejunal adenocarcinoma, bilateral ovary metastases, and peritoneal dissemination. First- and second-line chemotherapy for the gastric cancer failed. She was then treated with the immune checkpoint inhibitor nivolumab and had temporary improvement in her condition. To the best of our knowledge, this is the first case wherein nivolumab has been used to treat small bowel adenocarcinoma.
Literature
1.
go back to reference Neugut AI, Jacobson JS, Suh S, et al. The epidemiology of cancer of the small bowel. Cancer Epidemiol Biomarkers Prev. 1998;7:243–51. Neugut AI, Jacobson JS, Suh S, et al. The epidemiology of cancer of the small bowel. Cancer Epidemiol Biomarkers Prev. 1998;7:243–51.
2.
go back to reference Chow JS, Chen CC, Ahsan H, et al. A population-based study of the incidence of malignant small bowel tumours: SEER, 1973–1990. Int J Epidemiol. 1996;25:722–8.CrossRef Chow JS, Chen CC, Ahsan H, et al. A population-based study of the incidence of malignant small bowel tumours: SEER, 1973–1990. Int J Epidemiol. 1996;25:722–8.CrossRef
3.
go back to reference Bilimoria KY, Bentrem DJ, Wayne JD, et al. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg. 2009;249:63–71.CrossRef Bilimoria KY, Bentrem DJ, Wayne JD, et al. Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Ann Surg. 2009;249:63–71.CrossRef
4.
go back to reference Shenoy S. Genetic risks and familial associations of small bowel carcinoma. World J Gastrointest Oncol. 2016;8:509–19.CrossRef Shenoy S. Genetic risks and familial associations of small bowel carcinoma. World J Gastrointest Oncol. 2016;8:509–19.CrossRef
5.
go back to reference Aparicio T, Zaanan A, Svrcek M, et al. Small bowel adenocarcinoma: epidemiology, risk factors, diagnosis and treatment. Dig Liver Dis. 2014;46:97–104.CrossRef Aparicio T, Zaanan A, Svrcek M, et al. Small bowel adenocarcinoma: epidemiology, risk factors, diagnosis and treatment. Dig Liver Dis. 2014;46:97–104.CrossRef
6.
go back to reference Syngal S, Brand RE, Church JM, American College of Gastroenterology, et al. ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015;110:223–62.CrossRef Syngal S, Brand RE, Church JM, American College of Gastroenterology, et al. ACG clinical guideline: Genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol. 2015;110:223–62.CrossRef
7.
go back to reference Giardiello FM, Brensinger JD, Tersmette AC, et al. Very high risk of cancer in familial Peutz–Jeghers syndrome. Gastroenterology. 2000;119(06):1447–53.CrossRef Giardiello FM, Brensinger JD, Tersmette AC, et al. Very high risk of cancer in familial Peutz–Jeghers syndrome. Gastroenterology. 2000;119(06):1447–53.CrossRef
8.
9.
go back to reference Aparicio T, Zaanan A, Mary F, et al. Small bowel adenocarcinoma. Gastroenterol Clin North Am. 2016;45:447–57.CrossRef Aparicio T, Zaanan A, Mary F, et al. Small bowel adenocarcinoma. Gastroenterol Clin North Am. 2016;45:447–57.CrossRef
10.
go back to reference Hampel H, de la Chapelle A. The search for unaffected individuals with Lynch syndrome: do the ends justify the means? Cancer Prev Res (Phila). 2011;4:1–5.CrossRef Hampel H, de la Chapelle A. The search for unaffected individuals with Lynch syndrome: do the ends justify the means? Cancer Prev Res (Phila). 2011;4:1–5.CrossRef
11.
go back to reference Kappelman MD, Rifas-Shiman SL, Kleinman K, et al. The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol. 2007;5:1424–9.CrossRef Kappelman MD, Rifas-Shiman SL, Kleinman K, et al. The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol. 2007;5:1424–9.CrossRef
12.
go back to reference Lepage C, Bouvier AM, Manfredi S, et al. Incidence and management of primary malignant small bowel cancers: a well-defined French population study. Am J Gastroenterol. 2006;101:2826–32.CrossRef Lepage C, Bouvier AM, Manfredi S, et al. Incidence and management of primary malignant small bowel cancers: a well-defined French population study. Am J Gastroenterol. 2006;101:2826–32.CrossRef
13.
go back to reference Hong SH, Koh YH, Rho SY, et al. Primary adenocarcinoma of the small intestine: presentation, prognostic factors and clinical outcome. Jpn J Clin Oncol. 2009;39:54–61.CrossRef Hong SH, Koh YH, Rho SY, et al. Primary adenocarcinoma of the small intestine: presentation, prognostic factors and clinical outcome. Jpn J Clin Oncol. 2009;39:54–61.CrossRef
14.
go back to reference Takayoshi K, Kusaba H, Uenomachi M, et al. Suggestion of added value by bevacizumab to chemotherapy in patients with unresectable or recurrent small bowel cancer. Cancer Chemother Pharmacol. 2017;80:333–42.CrossRef Takayoshi K, Kusaba H, Uenomachi M, et al. Suggestion of added value by bevacizumab to chemotherapy in patients with unresectable or recurrent small bowel cancer. Cancer Chemother Pharmacol. 2017;80:333–42.CrossRef
15.
go back to reference Howe JR, Karnell LH, Menck HR, et al. Adenocarcinoma of the small bowel: review of the National Cancer Data Base. Cancer 1985-1995;86:2693–2706. Howe JR, Karnell LH, Menck HR, et al. Adenocarcinoma of the small bowel: review of the National Cancer Data Base. Cancer 1985-1995;86:2693–2706.
16.
go back to reference Halfdanarson TR, McWilliams RR, Donohue JH, et al. A single-institution experience with 491 cases of small bowel adenocarcinoma. Am J Surg. 2010;199:797–803.CrossRef Halfdanarson TR, McWilliams RR, Donohue JH, et al. A single-institution experience with 491 cases of small bowel adenocarcinoma. Am J Surg. 2010;199:797–803.CrossRef
17.
go back to reference Dabaja BS, Suki D, Pro B, et al. Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer. 2004;101:518–26.CrossRef Dabaja BS, Suki D, Pro B, et al. Adenocarcinoma of the small bowel: presentation, prognostic factors, and outcome of 217 patients. Cancer. 2004;101:518–26.CrossRef
18.
go back to reference Umman P, Adiyodi V, Narayan C. Small bowel adenocarcinoma—report of two cases and review of literature. Indian J Surg. 2013;75:123–7.CrossRef Umman P, Adiyodi V, Narayan C. Small bowel adenocarcinoma—report of two cases and review of literature. Indian J Surg. 2013;75:123–7.CrossRef
19.
go back to reference Hong SH, Koh YH, Rho SY, et al. Primary adenocarcinoma of the small intestine: presentation, prognostic factors and clinical outcome. Jpn J Clin Oncol. 2009;39:54–61.CrossRef Hong SH, Koh YH, Rho SY, et al. Primary adenocarcinoma of the small intestine: presentation, prognostic factors and clinical outcome. Jpn J Clin Oncol. 2009;39:54–61.CrossRef
20.
go back to reference Schwameis K, Schoppmann SF, Stift J, et al. Small bowel adenocarcinoma—terra incognita: a demand for cross-national pooling of data. Oncol Lett. 2014;7:1613–7.CrossRef Schwameis K, Schoppmann SF, Stift J, et al. Small bowel adenocarcinoma—terra incognita: a demand for cross-national pooling of data. Oncol Lett. 2014;7:1613–7.CrossRef
21.
go back to reference Lech G, Korcz W, Kowalczyk E, et al. Primary small bowel adenocarcinoma: current view on clinical features, prognostic factors, treatment and outcome. Scand J Gastroenterol. 2017;52:1194–202.CrossRef Lech G, Korcz W, Kowalczyk E, et al. Primary small bowel adenocarcinoma: current view on clinical features, prognostic factors, treatment and outcome. Scand J Gastroenterol. 2017;52:1194–202.CrossRef
22.
go back to reference Overman MJ, Varadhachary GR, Kopetz S, et al. Phase II study of capecitabine and oxaliplatin for advanced adenocarcinoma of the small bowel and ampulla of Vater. J Clin Oncol. 2009;27:2598–603.CrossRef Overman MJ, Varadhachary GR, Kopetz S, et al. Phase II study of capecitabine and oxaliplatin for advanced adenocarcinoma of the small bowel and ampulla of Vater. J Clin Oncol. 2009;27:2598–603.CrossRef
23.
go back to reference Xiang XJ, Liu YW, Zhang L, et al. A phase II study of modified FOLFOX as first-line chemotherapy in advanced small bowel adenocarcinoma. Anticancer Drugs. 2012;23:561–6.CrossRef Xiang XJ, Liu YW, Zhang L, et al. A phase II study of modified FOLFOX as first-line chemotherapy in advanced small bowel adenocarcinoma. Anticancer Drugs. 2012;23:561–6.CrossRef
25.
go back to reference Kotoe T, et al. Suggestion of added value by bevacizumab to chemotherapy in patients with unresectable or recurrent small bowel cancer. Cancer Chemother Pharmacol. 2017;80:333–42.CrossRef Kotoe T, et al. Suggestion of added value by bevacizumab to chemotherapy in patients with unresectable or recurrent small bowel cancer. Cancer Chemother Pharmacol. 2017;80:333–42.CrossRef
26.
go back to reference Gulhati P, Raghav K, Shroff R, et al. Phase II study of panitumumab in RAS wild-type metastatic adenocarcinoma of small bowel or ampulla of Vater. Oncologist. 2018;23:277e26.CrossRef Gulhati P, Raghav K, Shroff R, et al. Phase II study of panitumumab in RAS wild-type metastatic adenocarcinoma of small bowel or ampulla of Vater. Oncologist. 2018;23:277e26.CrossRef
27.
go back to reference Otsuji E, Yamaguchi T, Sawai K, et al. Characterization of signet ring cell carcinoma of the stomach. J Surg Oncol. 1998;67:216–20.CrossRef Otsuji E, Yamaguchi T, Sawai K, et al. Characterization of signet ring cell carcinoma of the stomach. J Surg Oncol. 1998;67:216–20.CrossRef
28.
go back to reference Makino T, Mishima H, Ikenaga M, et al. Clinicopathologic features of signet-ring cell carcinoma of the colon and rectum. Jpn J Gastroenterol Surg. 2006;39:16–22.CrossRef Makino T, Mishima H, Ikenaga M, et al. Clinicopathologic features of signet-ring cell carcinoma of the colon and rectum. Jpn J Gastroenterol Surg. 2006;39:16–22.CrossRef
29.
go back to reference Liu An-Chieh, Chen Ch, et al. A rare Krukenberg tumor arising from a primary adenocarcinoma of the small intestine. Taiwan J Obstet Gynecol. 2018;57(2):319–22.CrossRef Liu An-Chieh, Chen Ch, et al. A rare Krukenberg tumor arising from a primary adenocarcinoma of the small intestine. Taiwan J Obstet Gynecol. 2018;57(2):319–22.CrossRef
30.
go back to reference Woodruff JD, Novak ER. The Krukenberg tumor: study of 48 cases from the ovarian tumor registry. Obstet Gynecol. 1960;15:351–60. Woodruff JD, Novak ER. The Krukenberg tumor: study of 48 cases from the ovarian tumor registry. Obstet Gynecol. 1960;15:351–60.
31.
go back to reference Mitsushita J, Tanaka A, et al. Metastatic ovarian tumors originating from a small bowel adenocarcinoma–a case report and brief literature review. Int J Gynecol Pathol. 2017;36(3):253–60.CrossRef Mitsushita J, Tanaka A, et al. Metastatic ovarian tumors originating from a small bowel adenocarcinoma–a case report and brief literature review. Int J Gynecol Pathol. 2017;36(3):253–60.CrossRef
32.
go back to reference Kang YK, Boku N, Satoh T, et al. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;390:2461–71.CrossRef Kang YK, Boku N, Satoh T, et al. Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 2017;390:2461–71.CrossRef
33.
go back to reference Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (ver. 5). Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2018 (ver. 5).
34.
go back to reference Shahabi V, Postow MA, et al. Immune-priming of the tumor microenvironment by radiotherapy: rationale for combination with immunotherapy to improve anticancer efficacy. Am J Clin Oncol. 2015;38(1):90–7.CrossRef Shahabi V, Postow MA, et al. Immune-priming of the tumor microenvironment by radiotherapy: rationale for combination with immunotherapy to improve anticancer efficacy. Am J Clin Oncol. 2015;38(1):90–7.CrossRef
35.
go back to reference Seyedin SN, Schoenhals JE, et al. Strategies for combining immunotherapy with radiation for anticancer therapy. Immunotherapy. 2015;7(9):967–80.CrossRef Seyedin SN, Schoenhals JE, et al. Strategies for combining immunotherapy with radiation for anticancer therapy. Immunotherapy. 2015;7(9):967–80.CrossRef
36.
go back to reference Hecht MI, Büttner-Herold M, et al. PD-L1 is upregulated by radiochemotherapy in rectal adenocarcinoma patients and associated with a favourable prognosis. Eur J Cancer. 2016;65:52–60.CrossRef Hecht MI, Büttner-Herold M, et al. PD-L1 is upregulated by radiochemotherapy in rectal adenocarcinoma patients and associated with a favourable prognosis. Eur J Cancer. 2016;65:52–60.CrossRef
37.
go back to reference De Wolf K, Kruse V, et al. A phase II trial of stereotactic body radiotherapy with concurrent anti-PD1 treatment in metastatic melanoma: evaluation of clinical and immunologic response. J Transl Med. 2017;31;15(1):21. De Wolf K, Kruse V, et al. A phase II trial of stereotactic body radiotherapy with concurrent anti-PD1 treatment in metastatic melanoma: evaluation of clinical and immunologic response. J Transl Med. 2017;31;15(1):21.
38.
go back to reference Le DT, et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med. 2015;372(26):2509–20.CrossRef Le DT, et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med. 2015;372(26):2509–20.CrossRef
39.
go back to reference Kim ST, Cristescu R, et al. Comprehensive molecular characterization of clinical responses to PD-1 inhibition in metastatic gastric cancer. Nat Med. 2018;24(9):1449–58.CrossRef Kim ST, Cristescu R, et al. Comprehensive molecular characterization of clinical responses to PD-1 inhibition in metastatic gastric cancer. Nat Med. 2018;24(9):1449–58.CrossRef
Metadata
Title
A case of small bowel adenocarcinoma wherein nivolumab conferred temporary benefit in disease control
Authors
Kazutaka Iijima
Mitsuharu Oozeki
Kaori Ikeda
Hiroyuki Honda
Hajime Ishibashi
Masaharu Yamaoka
Shinji Fujieda
Hitoaki Saitoh
Mitsuhide Goto
Masahiro Araki
Kenji Amagai
Publication date
01-06-2020
Publisher
Springer Singapore
Published in
Clinical Journal of Gastroenterology / Issue 3/2020
Print ISSN: 1865-7257
Electronic ISSN: 1865-7265
DOI
https://doi.org/10.1007/s12328-019-01064-9

Other articles of this Issue 3/2020

Clinical Journal of Gastroenterology 3/2020 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.