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Review
. 2022 Mar 2;14(5):1287.
doi: 10.3390/cancers14051287.

Molecular Landscape of Small Bowel Adenocarcinoma

Karan Pandya  1   2 , Michael J Overman  3 , Pat Gulhati  1   2
Affiliations
Review

Molecular Landscape of Small Bowel Adenocarcinoma

Karan Pandya et al. Cancers (Basel). .

Abstract

Small bowel adenocarcinoma (SBA) is a rare malignancy, with lower incidence, later stage at diagnosis, and poor overall prognosis compared to other cancers of the gastrointestinal tract. Owing to the rarity of the disease along with the paucity of high-quality tissue samples and preclinical models, little is known about the molecular alterations characteristic of SBA. This is reflected by the fact that the clinical management of SBA is primarily extrapolated from colorectal cancer (CRC). Recent advances in genomic profiling have highlighted key differences between these tumors, establishing SBA as a molecularly unique intestinal cancer. Moreover, comprehensive molecular analysis has identified a relatively high incidence of potentially targetable genomic alterations in SBA, predictive of response to targeted and immunotherapies. Further advances in our knowledge of the mutational and transcriptomic landscape of SBA, guided by an increased understanding of the molecular drivers of SBA, will provide opportunities to develop novel diagnostic tools and personalized therapeutic strategies.

Keywords: BRAF alteration; ERBB2/HER2 alteration; colorectal cancer (CRC); gastric cancer (GC); microsatellite instability (MSI); small bowel adenocarcinoma; tumor mutational burden (TMB).

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Frequency of genomic alterations in Small Bowel Adenocarcinoma (SBA), Colorectal Cancer (CRC), and Gastric Carcinoma (GC) [1]. (A) Genomic alterations noted in >7% of SBA patients, with corresponding genomic alteration frequencies in CRC and GC patients [1]. (B) BRAF (above) and ERBB2/HER2 (below) alteration frequencies in SBA, CRC, and GC cohorts, by type of alteration [1].
Figure 2
Figure 2
Major differences in genomic alteration frequencies between SBA and GC (A), SBA subsites (B), and SBA and CRC (C) [1]. Adapted with permission form [2].
Figure 3
Figure 3
Flow diagram outlining management with incorporation of molecular analysis to determine the treatment plan for unresectable/metastatic SBA patients.
See this image and copyright information in PMC

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