Randomized, non-comparative, open-label, multi-centre Phase II study to evaluate modified FOLFIRINOX and modified FOLFOX in the locally advenced or metastatic small bowel adenocarcinoma.

The primary objective is to assess the percentage of patients alive without prograssion at 8 months.

Inclusion Criteria:

• Histologically proven adenocarcinoma of the small intestine (duodenum, jejunum, ileum)
• Metastatic or locally advanced unresectable tumour with curative intent
• Patient who never received first-line chemotherapy
• Measurable lesion according to RECIST 1.1 criteria
• ECOG status < or = 2 for patients under 70 years, or 0 or 1 for patients over 70 years
• Life expectancy estimated at over 3 months
• Patient over 18 years of age
• Patient able to understand and sign the information and informed consent note
• Women of childbearing age and men who have sex with women of childbearing age must agree to use contraception during the trial treatment and for at least 9 months after stopping the experimental treatments.

Exclusion Criteria:

• MSI/dMMR tumor
• Adenocarcinoma of the ampulla of Vater
• Neutrophils < 1500/mm3, platelets < 100 000/mm3
• Hemoglobin < 9 g/dL, total bilirubin > 1.5x normal, alkaline phosphatase > 2.5x normal (or >5x normal if liver metastases), creatinine clearance > or = 40 ml/min. according to MDRD
• Hypokalaemia, hypomagnesaemia and hypocalcaemia below normal, and for calcaemia, it must be corrected before enrolment.
• Adjuvant chemotherapy completed less than 6 months ago
• History of myocardial infarction within the last 6 months, severe coronary artery disease or severe heart failure
• Severe renal failure
• Peripheral sensory neuropathy with functional discomfort
• Active and/or potentially severe infection or other uncontrolled conditions
• Treatment with a cytochrome P450 inhibitor within 4 weeks prior to the administration of the protocol treatment (refer to paragraph 8.3 "Contraindicated treatments" of the protocol)
• Patients currently undergoing treatment using St John's Wort
• Treatment with brivudine within 4 weeks prior to the administration of protocol