Background Data about the use and efectiveness of targeted therapy in metastatic small bowel adenocarcinoma (SBA) are scarce. Objective The aim of this population-based study was to obtain insights into the use and efectiveness of targeted therapy in patients with synchronous metastases of SBA. Patients and methods Data were retrieved from the Netherlands Cancer Registry. Patients treated with palliative chemotherapy and/or targeted therapy for synchronous metastatic SBA between 2007 and 2016 were included (n=187). Diferences in treatment and the subsequent efects on overall survival (OS) were evaluated. Results In frst-line treatment, 25 patients (13%) received additional targeted therapy, exclusively bevacizumab, and mostly in combination with CAPOX/FOLFOX (n=24). A primary ileal tumour was predictive for receiving bevacizumab in frstline treatment (odds ratio 3.2, 95% confdence interval (CI) 1.06–9.93). Median OS for patients in whom bevacizumab was added to frst-line chemotherapy was 9.3 months, compared to 9.1 months with chemotherapy only (p=0.85). Median OS for patients receiving frst-line treatment only was 8.5 months with and 6.4 months without the addition of bevacizumab, respectively (p=0.54). In multivariable survival analyses, the addition of bevacizumab was no prognostic factor (hazard ratio 1.01, 95% CI 0.65–1.59). Conclusions Bevacizumab was the only prescribed targeted therapy in frst-line treatment. Considering the limited number of patients receiving frst-line bevacizumab and the unknown reasons to prescribe additional targeted therapy, the corresponding survival rates of patients treated with and without additional bevacizumab in frst-line treatment might suggest a limited clinical efect of bevacizumab in addition to frst-line palliative chemotherapy on OS. Future research should focus on identifying the subgroup of patients who might beneft from anti-VEGF therapy in metastatic SBA.

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Journal Targeted Oncology
Legue, LM, van Erning, F.N, Bernards, N, Lemmens, V.E.P.P, de Hingh, I., & Creemers, GJ. (2019). Addition of Bevacizumab to First-Line Palliative Chemotherapy in Patients with Metastatic Small Bowel Adenocarcinoma: A Population-Based Study. Targeted Oncology. doi:10.1007/s11523-019-00681-1