Small bowel adenocarcinoma (SBA) is a rare tumor that accounts for 37% of small bowel malignancies and <2% of all gastrointestinal tumors.1 Although surgery remains the mainstay of therapy, most patients present with advanced disease, and 5-year overall survival (OS) rates range from 26% to 40%.2 Because of its low incidence and lack of available trials, current chemotherapy regimens used for adjuvant or metastatic SBA are extrapolated from colorectal cancer (CRC) and gastric cancer, with poor results.3 Overexpression of the HER2 protein and amplification of the ERBB2 gene has been observed in various adenocarcinomas, providing a therapeutic target that can be used to extend the survival of a select cohort of patients. Anti-HER2 therapy has been successfully applied to gastric cancer and CRC, but its use and potential benefit in small intestinal carcinomas is not well characterized.4,5 We applied anti-HER2 therapy to an ERBB2-amplified advanced duodenal adenocarcinoma, adding trastuzumab to FOLFOX in the neoadjuvant setting, to achieve a complete pathologic response (cPR) in the resected specimen.
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. Bang YJ Van Cutsem E Feyereislova A Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010; 376: 687– 697.
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. Sartore-Bianchi A Trusolino L Martino C Dual-targeted therapy with trastuzumab and lapatinib in treatment-refractory, KRAS codon 12/13 wild-type, HER2-positive metastatic colorectal cancer (HERACLES): a proof-of-concept, multicentre, open-label, phase 2 trial. Lancet Oncol 2016; 17: 738– 746.
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