Around 350 patients are diagnosed with small bowel (intestine) cancer each year in the Netherlands. It is a relatively rare form of bowel cancer and, as a result, treatment guidelines are often adapted from colorectal cancer, which is much more common and better understood. However, small bowel cancer progression and biology is different from colorectal cancer, and a comprehensive characterization of the underlying biology would lead to better prediction of treatment choices and outcomes.
One size doesn’t fit all
For colorectal cancer, treatment choice can be guided by the genes expressed in the tumor or by mutations in the tumor DNA. For small bowel cancer there are currently no prognostic and predictive markers or molecular tumor characteristics that could guide treatment decisions. It is therefore very likely that patients are currently under- and over-treated with either systemic medication and/or surgical interventions. To improve quality of life and survival of small bowel cancer patients, this needs to change.
Filling the knowledge gap
The Prospective National Colorectal Cancer (PLCRC) cohort collects data to facilitate scientific research and improve prognosis for colorectal cancer patients. It was established in 2014 and now has 63 participating centers across the Netherlands. Dr. Dirkje Sommeijer and her team at Cancer Center Amsterdam plan to develop a similar database for small bowel cancer and incorporate it into the PLCRC cohort.
“After patient consent, we will collect patient data from the Dutch Cancer Registry, record quality-of-life data, as well as store biological samples of tumor tissue and blood,” says Dr. Sommeijer. Her team will then use this information to study the relationship between tumor characteristics, patient characteristics, therapy sensitivity, quality of life, and disease outcome. Furthermore, the information will allow her team to answer key research questions:
- How are patients with small bowel cancer diagnosed and at what stage of the disease?
- What are the key molecular tumor characteristics of small bowel cancer?
- What is the relationship between currently used systemic and surgical treatments and longevity?
- What is the effect of systemic and surgical therapies on longevity and patient quality of life?
"Our ultimate mission to improve the longevity and quality of life of small bowel cancer patients,” Dr. Dirkje Sommeijer.
Efficiency through collaboration
Dr. Sommeijer expects it will take four years to set up the small bowel cancer cohort. This can be achieved because her team will collaborate with the Dutch Cancer Registry and benefit from the existing PLCRC infrastructure. We aim to recruit 540 patients during the next four years of the project,” she says.
A future of informed decision making
The new nationwide prospective cohort for small bowel cancer will also explore the biological characteristics of the disease. “We will study mutations and gene expression of 180 tumors to find genes or proteins that influence prognosis and therapy sensitivity and to identify molecular subtypes,” says Dr. Sommeijer. “We will then look for associations with the other patient data we have collected.”
In addition, the database will be a valuable source of data for the cancer research community and will be used to inform national guidelines for small bowel cancer treatment in the future. Going forward, the cohort study will serve as a framework for future patient studies into this rare tumor type and create a solid foundation for international collaboration. We are therefore aiming to continue the small bowel cohort after the four years of this KWF project.
“Above all our project will lead to a more tailor-made treatment approach. Our ultimate mission to improve the longevity and quality of life of small bowel cancer patients,” concludes Dr. Sommeijer.
For more information contact Dr. Dirkje Sommeijer.
Dr. Dirkje Sommeijer
Tim de Back
Prof. Louis Vermeulen
Text by Lynita Howie.