Intraperitoneal and Systemic Chemotherapy for Patients with Gastric Cancer with Peritoneal Metastasis: A Phase II Trial

Abstract

Aim: To conduct a phase II study of single intraperitoneal (i.p.) administration of paclitaxel followed by paclitaxel, cisplatin, and S-1 (PCS) chemotherapy for patients with gastric cancer with peritoneal metastasis (PM). Patients and Methods: Staging laparotomy was performed to confirm PM. Initially, patients received i.p. paclitaxel. Beginning 7 days later, PCS was given every 3 weeks followed by second-look laparoscopy. Primary and secondary endpoints were the overall survival (OS) rate, and response rate and patient safety, respectively. Results: Seventeen patients were enrolled. The overall response rate was 70.5% (12/17). Grade 3/4 toxic effects included neutropenia and leukopenia. After chemotherapy, PM disappearance was confirmed in 11 patients. Gastrectomy was eventually performed in 11 patients. The 1-year OS rate was 82.4% and the median survival time was 23.9 months considering the overall cohort. Conclusion: Combination chemotherapy with i.p. paclitaxel and PCS is well tolerated and effective in patients with gastric cancer with PM.

Retrospective Cohort Study of Intraoperative Administration of Sustained-Release 5-Fluorouracil Implants in Advanced Gastric Cancer Patients

“…Although many methods have been developed to conquer the peritoneal metastasis, such as hyperthermic intraperitoneal chemotherapy (HIPEC) (Yarema et al, 2019), pressurized intraperitoneal erosol chemotherapy (PIPAC) (Sgarbura et al, 2019), the outcome of GC with peritoneal metastasis is still unsatisfied. Intraperitoneal (IP) infusion of chemotherapy drugs offers an attempt to expose cancer cells to anti-cancer drugs at high drug concentrations with minimal systemic toxic effects (Shinkai et al, 2018), but implantation of the port may cause some complications. Yang et al reported that 22.9% patients experienced port complications, including subcutaneous liquid accumulation, infection, port rotation, inflow obstruction, and even subcutaneous metastasis (Yang et al, 2020).…”

<p>Lobaplatin in Prophylactic Hyperthermic Intraperitoneal Chemotherapy for Advanced Gastric Cancer: Safety and Efficacy Profiles</p>

“…Intravenous chemotherapy was found to neither significantly lower the rate of peritoneal recurrence nor improve prognosis for patients with peritoneal gastric cancer recurrence. 6,12 It is thus urgent to establish treatment methods utilizing efficacious drugs. Due to the plasma-peritoneal barrier, most intravenous chemotherapeutic agents do not remain in sufficient contact with lesions.…”

“…13 Compared with intravenous chemotherapy, HIPEC has significant advantagesnotably the relative ease of attaining higher drug concentrations and a lower incidence of side effectswith proven beneficial effects in the treatment of gastric, colorectal, ovarian and other cancers. 6,[14][15][16] To date, a number of studies have confirmed the advantages of cytoreductive surgery (CRS) in combination with HIPEC for gastric cancer treatment. Cisplatin combined with 5-fluorouracil and mitomycin C has been the most widely studied HIPEC regimen.…”

“…[2][3][4] Prior studies have confirmed that cytoreductive surgery in addition to hyperthermic intraperitoneal chemotherapy (HIPEC) significantly improves the prognosis of patients suffering peritoneal gastric cancer metastases. [5][6][7] Compared with cisplatin and carboplatin, lobaplatin, a third-generation alkylating antineoplastic agent, exhibits good water-solubility, a wide anticancer spectrum and high antitumor activity. Harstrick et al 8 verified the effectiveness of lobaplatin on gastric cancer cell lines and also found that it markedly inhibited several cisplatinresistant cell lines.…”

SOX combined with intraperitoneal perfusion of docetaxel compared with DOS regimen in the first-line therapy for advanced gastric cancer with malignant ascites: a prospective observation

“…The primary objective of this study was to demonstrate that OS rate of patients treated with D-SOX was superior to that of patients treated with DOS. On the basis of previous research results [ 6 , 7 ], we assume that the 1-year OS rate of D-SOX and DOS are 75% and 50%, respectively. According to Lachin-Foulkes method (PASS 11.0, NCSS, USA), one-sided log-rank test was adopted with α of 0.05, 90% power, and 5.0% loss, and the target sample size was set at 78 patients.…”