Treatments for unresectable small intestine cancer

The following are treatment options for unresectable small intestine adenocarcinoma. This means that the cancer can’t be completely removed with surgery and has often metastasized (spread to other parts of the body). Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan.

Chemotherapy uses anticancer drugs to destroy cancer cells. It is usually offered for unresectable small intestine adenocarcinoma.

You may have chemotherapy to:

• relieve pain or control symptoms if the cancer has spread (called palliative chemotherapy)
• try to shrink a tumour so it can be removed with surgery
• control the disease to help you live longer

Chemotherapy may be the only treatment you have or it may be used along with other cancer treatments.

Chemotherapy combined with radiation therapy (called chemoradiation) may also be used. You may be offered chemoradiation to shrink a localized tumour enough so it can be removed with surgery.

Some chemotherapy drugs and chemotherapy drug combinations that may be used to treat unresectable small intestine adenocarcinoma 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, fluorouracil and irinotecan
• FOLFOXIRI – 5-FU, leucovorin, oxaliplatin and irinotecan

Find out more about chemotherapy for small intestine adenocarcinoma.

You may be offered surgery to relieve pain and other symptoms caused by small intestine adenocarcinoma, such as nausea and vomiting. 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 repair a hole in the intestine (called a bowel perforation).

Find out more about surgery for small intestine adenocarcinoma.

Radiation therapy uses high-energy rays or particles to destroy cancer cells.

You may be offered radiation therapy for unresectable small intestine adenocarcinoma. It is most often used to relieve pain or control the symptoms of advanced cancer (called palliative care). It can be used to stop bleeding caused by the tumour and relieve pain and pressure on surrounding tissues. It can also be used to treat pain where the cancer has metastasized, such as to the bones.

In very rare cases, radiation therapy or chemoradiation may be used to shrink a tumour before surgery.

Find out more about radiation therapy 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 unresectable small intestine adenocarcinoma.

The neurotrophic tyrosine receptor kinase (NTRK) gene tells nerve cells to make a protein that helps the cells send information about certain bodily sensations. An NTRK gene fusion is when part of the NTRK gene breaks off and joins with another gene. 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 unresectable 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 unresectable 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.

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.