Big targets come in small bowels.

In the realm of cancer, it seems all small bowels lead to chemotherapy. Small bowel adenocarcinomas are often neither amenable to complete surgical resection nor reliable targets for radiation. Unfortunately, conventional chemo has historically served as a poor fall back. This summer brings us data on hundreds of prospectively genomically analyzed gastric, small bowel and colorectal adenos showing that the differences among them are far more complex than anatomy. A whopping 91% of small bowels adenos were found to have potentially targetable mutations. And, perhaps more exciting, they also had the highest rates of microsatellite instability and high mutational burden--both strong indicators of response to well-known immunotherapies (we see you, Keytruda). If 2017 hasn’t impressed you with its apocalyptic signs yet, it just brought you a potential effective treatment for small bowel cancer...