What adjuvant treatment would you offer after repeat surgery for a locally recurrent, lymph node positive small bowel adenocarcinoma with residual neuropathy after prior FOLFOX?

There is no good data for small bowel adenocarcinoma and a lot of treatment is extrapolated from colon cancer literature. If the patient had recurrent disease after initial surgery and adjuvant FOLFOX, the benefit of further chemotherapy as adjuvant treatment is questionable. I would not recommend c...

I would pursue genetic/MSI testing and see if the patient had fit in a trial. We had success with the MDM2 inhibitor study. This is a difficult disease and needs innovative therapy.