Advanced and metastatic small bowel adenocarcinoma: lines of therapy
5 standard-of-care settings across 3 lines and 3 biomarker subgroups. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.
Advanced, first line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| MSI-H / dMMR | First line, mismatch-repair proficient | CAPOX or FOLFOX, with bevacizumab considered; taxane-based regimens as an alternative. | NCCN Guidelines: Small Bowel Adenocarcinoma | 98 | |
| MSI-H / dMMR | First line, mismatch-repair deficient | Pembrolizumab (tumour-agnostic approval); nivolumab with ipilimumab as an alternative. | NCCN Guidelines: Small Bowel Adenocarcinoma | 99 |
Second line
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Second line | FOLFIRI or a taxane; pembrolizumab if mismatch-repair deficient and not yet given; trastuzumab-based therapy or trastuzumab deruxtecan for HER2-positive tumours. | NCCN Guidelines: Small Bowel Adenocarcinoma | 98 |
Other settings
| Subgroup | Setting | Approach | Products and trials | Guideline | Evidence |
|---|---|---|---|---|---|
| All comers | Limited metastases | Resection of liver metastases or cytoreductive surgery with HIPEC for limited peritoneal disease in selected patients. | NCCN Guidelines: Small Bowel Adenocarcinoma | 80 | |
| HER2 | All patients | Comprehensive genomic profiling to find HER2, mismatch repair deficiency and rare actionable alterations; referral to trials. | NCCN Guidelines: Small Bowel Adenocarcinoma | 81 |
Sequence and caution pairings
Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.