Treatments for recurrent small intestine cancer

Recurrent small intestine adenocarcinoma means that the cancer has come back after it has been treated.

Sometimes when this cancer comes back, the tumour is too big to be removed with surgery (unresectable). The cancer may also have metastasized( spread to other parts of the body).

There are no standard treatments for recurrent small intestine adenocarcinoma. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. You may be offered one or a combination of the following treatments. You will usually be offered palliative care.

Chemotherapy uses anticancer drugs to destroy cancer cells. You may be offered chemotherapy for recurrent small intestine adenocarcinoma that has spread to other parts of the body.

Because this type of cancer is rare, there is no standard chemotherapy regimen. Your doctor may use a chemotherapy combination you have not had before. The most common chemotherapy drugs and chemotherapy drugs combinations offered for recurrent small intestine adenocarcinoma cancer are:

• FOLFOX – leucovorin (folinic acid), 5-fluorouracil (also called 5-FU or fluorouracil) and oxaliplatin
• CAPOX – capecitabine (Xeloda) and oxaliplatin
• 5-FU or capecitabine
• FOLFIRI – leucovorin, 5-FU and irinotecan
• FOLFOXIRI – 5-FU, leucovorin, oxaliplatin and irinotecan

Researchers are currently looking into which chemotherapy drugs and drug combinations can best treat metastatic cancer.

Find out more about chemotherapy for small intestine adenocarcinoma.

Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them to stop the growth and spread of cancer. You may have neurotrophic tyrosine receptor kinase (NTRK) therapy to treat recurrent small intestine adenocarcinoma that has metastasized.

The neurotrophic tyrosine receptor kinase (NTRK) gene tells nerve cells to make a protein that helps the cells send information about certain bodily sensations. When part of the NTRK gene breaks off and joins with another gene, it is called an NTRK gene fusion. This change causes abnormal proteins called TRK fusion proteins, which may cause cancer cells to grow.

The following drugs may be used to treat metastatic small intestine adenocarcinoma with an NTRK gene fusion:

• larotrectinib (Vitrakvi)
• entrectinib (Rozlytrek)

Find out more about targeted therapy for small intestine adenocarcinoma.

Immunotherapy (also called biological therapy) helps to strengthen or restore the immune system's ability to fight cancer. Immunotherapy drugs may be offered for recurrent small intestine adenocarcinoma if the tumour has certain genetic changes defined as high microsatellite instability (MSI-H) or mismatch repair deficiency (dMMR). These drugs will only be tried if the cancer has spread and doesn't respond to other treatments.

The type of immunotherapy drugs used are called immune checkpoint inhibitors. The immune system normally stops itself from attacking normal cells in the body by using specific proteins called checkpoints. Checkpoints slow down or stop an immune system response. Some small intestine cancer cells can use these checkpoints to hide and avoid being attacked by the immune system. Immune checkpoint inhibitors work by blocking the checkpoint proteins so immune system cells (called T cells) attack and kill the cancer cells.

The following immune checkpoint inhibitors may be used to treat recurrent small intestine adenocarcinoma:

• pembrolizumab (Keytruda)
• nivolumab (Opdivo)
• dostarlimab (Jemperli)

Immunotherapy drugs for MSI-H or dMMR tumours may not be covered by all provincial or territorial drug plans. Your doctor or healthcare team will discuss access to these drugs with you and if you may benefit from this treatment.

Find out more about immunotherapy for small intestine adenocarcinoma.

Radiation therapy uses high-energy rays or particles to destroy cancer cells. You may be offered radiation therapy as a palliative treatment for recurrent small intestine adenocarcinoma. It is used to stop bleeding caused by a tumour or to treat pain where cancer has spread.

Find out more about radiation therapy for small intestine adenocarcinoma.

Your healthcare team will discuss treatment options with you and if surgery is possible. This will depend on your health and preferences, the size and location of the tumour, and possible side effects and complications.

Surgery is most often offered to relieve pain and other symptoms caused by recurrent small intestine adenocarcinoma that has metastasized. This is called palliative surgery.

The surgeon may do a surgical bypass to allow digested food and fluid to go around, or bypass, a tumour in the small intestine. In some cases, the surgeon may remove part of the tumour. Another way the surgeon can create a bypass is by putting a small tube (called a stent) through the tumour.

Surgery may also be done to open a blockage in the intestine (called a bowel obstruction) or to repair a hole in the intestine (called a bowel perforation) .

Find out more about surgery for small intestine adenocarcinoma.

Clinical trials look at new and better ways to prevent, find and treat cancer. Small intestine adenocarcinoma is rare, so very few clinical trials in Canada are open to people with this type of cancer. Talk to your doctor about clinical trials that you might be able to join.

Find out more about clinical trials.