Top

International Journal of Clinical Oncology

Published in:

11-07-2023 | Gastric Cancer | Original Article

Clinical significance of intraperitoneal paclitaxel combined with systemic chemotherapy for gastric cancer with peritoneal metastasis

Authors: Taiki Nakashima, Takaaki Arigami, Yoshikazu Uenosono, Daisuke Matsushita, Masataka Shimonosono, Yusuke Tsuruda, Ken Sasaki, Kenji Baba, Hiroshi Kurahara, Takao Ohtsuka

Published in: International Journal of Clinical Oncology | Issue 10/2023

Abstract

Background

Despite investigations of intraperitoneal paclitaxel as a personalized treatment for peritoneal metastasis of gastric cancer, few studies have evaluated its prognostic impact on conversion surgery for unresectable gastric cancer with peritoneal metastasis. Our study aimed to close this gap in knowledge.

Methods

We retrospectively enrolled 128 patients who underwent chemotherapy for peritoneal metastasis from gastric cancer and assigned them into intraperitoneal (IP) (n = 36) and non-IP (n = 92) groups, based on the use of intraperitoneal paclitaxel plus systemic chemotherapy.

Results

Disease control rates were 94% and 69% in the IP and non-IP groups, respectively, with the former having a significantly higher tumor response rate than the latter (p < 0.01). The median survival times in the IP and non-IP groups were 665 and 359 days, respectively, with the former having significantly better prognosis than the latter (p = 0.02). Fifteen (42%) and sixteen (17%) patients underwent conversion surgery after chemotherapy in the IP and non-IP groups, respectively, with the former having a significantly higher conversion surgery induction rate than the latter (p < 0.01). Although the prognosis of the conversion surgery group was significantly better than that of the non-conversion surgery group (p < 0.01), there was no significant difference in prognosis between patients in the IP and non-IP groups who underwent conversion surgery (p = 0.22). Multivariate analysis identified performance status and conversion surgery as independent prognostic factors (all p < 0.01).

Conclusion

Our study demonstrated that the IP chemotherapy was one of important factors for conversion surgery induction, while it was not a risk factor for prognosis.

Bray F, Ferlay J, Soerjomataram I et al (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492CrossRefPubMed

Kitayama J, Ishigami H, Yamaguchi H et al (2018) Treatment of patients with peritoneal metastases from gastric cancer. Ann Gastroenterol Surg 2:116–123. https://doi.org/10.1002/ags3.12060CrossRefPubMedPubMedCentral

Nakao T, Kaneko R, Tanaka H et al (2021) Contribution of chemotherapy to improved prognosis in stage 4 gastric cancer: trend analysis of a regional population-based cancer registry in Japan. Int J Clin Oncol 26:378–386. https://doi.org/10.1007/s10147-020-01820-9CrossRefPubMed

Arigami T, Matsushita D, Okubo K et al (2022) Changes in chemotherapeutic strategies and their prognostic impact in patients with advanced gastric cancer. In Vivo 36:409–415. https://doi.org/10.21873/invivo.12718CrossRefPubMedPubMedCentral

Kobayashi D, Kodera Y (2017) Intraperitoneal chemotherapy for gastric cancer with peritoneal metastasis. Gastric Cancer 20:111–121. https://doi.org/10.1007/s10120-016-0662-9CrossRefPubMed

Ishigami H, Fujiwara Y, Fukushima R et al (2018) Phase III trial comparing intraperitoneal and intravenous paclitaxel plus S-1 versus cisplatin plus S-1 in patients with gastric cancer with peritoneal metastasis: PHOENIX-GC trial. J Clin Oncol 36:1922–1929. https://doi.org/10.1200/JCO.2018.77.8613CrossRefPubMed

Saito S, Yamaguchi H, Ohzawa H et al (2021) Intraperitoneal administration of paclitaxel combined with S-1 plus oxaliplatin as induction therapy for patients with advanced gastric cancer with peritoneal metastases. Ann Surg Oncol 28:3863–3870. https://doi.org/10.1245/s10434-020-09388-4CrossRefPubMed

Chia DKA, Sundar R, Kim G et al (2022) Outcomes of a phase II study of intraperitoneal paclitaxel plus systemic capecitabine and oxaliplatin (XELOX) for gastric cancer with peritoneal metastases. Ann Surg Oncol 29:8597–8605. https://doi.org/10.1245/s10434-022-11998-zCrossRefPubMed

Kang SH, Min SH, Kim JW et al (2022) Safety and efficacy of intraperitoneal paclitaxel plus intravenous fluorouracil, leucovorin, and oxaliplatin (FOLFOX) for gastric cancer with peritoneal metastasis. Ann Surg Oncol 29:5084–5091. https://doi.org/10.1245/s10434-022-11582-5CrossRefPubMed

10.

Kitayama J, Emoto S, Yamaguchi H et al (2014) Intraperitoneal paclitaxel induces regression of peritoneal metastasis partly by destruction of peripheral microvessels. Cancer Chemother Pharmacol 73:605–612. https://doi.org/10.1007/s00280-014-2393-0CrossRefPubMed

11.

Yoshida K, Yamaguchi K, Okumura N et al (2016) Is conversion therapy possible in stage IV gastric cancer: the proposal of new biological categories of classification. Gastric Cancer 19:329–338. https://doi.org/10.1007/s10120-015-0575-zCrossRefPubMed

12.

Kodera Y (2018) Surgery with curative intent for stage IV gastric cancer: is it a reality of illusion? Ann Gastroenterol Surg 2:339–347. https://doi.org/10.1002/ags3.12191CrossRefPubMedPubMedCentral

13.

Kinoshita J, Yamaguchi T, Moriyama H et al (2021) Current status of conversion surgery for stage IV gastric cancer. Surg Today 51:1736–1754. https://doi.org/10.1007/s00595-020-02222-0CrossRefPubMed

14.

Yoshida K, Yasufuku I, Terashima M et al (2022) International retrospective cohort study of conversion therapy for stage IV gastric cancer 1 (CONVO-GC-1). Ann Gastroenterol Surg 6:227–240. https://doi.org/10.1002/ags3.12515CrossRefPubMed

15.

Satake S, Arigami T, Matsushita D et al (2023) Clinical significance of eligibility criteria determined by the SPIRITS trial in patients with advanced gastric cancer. Oncology 101:12–21. https://doi.org/10.1159/000527114CrossRefPubMed

16.

Amin MB, Edge S, Greene F et al (2017) AJCC cancer staging manual, 8th edn. Springer, New YorkCrossRef

17.

Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline, version 1.1. Eur J Cancer 45:228–247. https://doi.org/10.1016/j.ejca.2008.10.026CrossRefPubMed

18.

Japanese Gastric Cancer Association (2011) Japanese classification of gastric carcinoma: 3rd, English edn. Gastric Cancer 14:101–112. https://doi.org/10.1007/s10120-011-0041-5CrossRef

19.

Yamaguchi H, Kitayama J, Ishigami H et al (2013) A phase 2 trial of intravenous and intraperitoneal paclitaxel combined with S-1 for treatment of gastric cancer with macroscopic peritoneal metastasis. Cancer 119:3354–3358. https://doi.org/10.1002/cncr.28204CrossRefPubMed

20.

Kitayama J, Ishigami H, Yamaguchi H et al (2014) Salvage gastrectomy after intravenous and intraperitoneal paclitaxel (PTX) administration with oral S-1 for peritoneal dissemination of advanced gastric cancer with malignant ascites. Ann Surg Oncol 21:539–546. https://doi.org/10.1245/s10434-013-3208-yCrossRefPubMed

21.

Fukuchi M, Ishiguro T, Ogata K et al (2015) Prognostic role of conversion surgery for unresectable gastric cancer. Ann Surg Oncol 22:3618–3624. https://doi.org/10.1245/s10434-015-4422-6CrossRefPubMed

22.

Solaini L, Ministrini S, Bencivenga M et al (2019) Conversion gastrectomy for stage IV unresectable gastric cancer: a GIRCG retrospective cohort study. Gastric Cancer 22:1285–1293. https://doi.org/10.1007/s10120-019-00968-2CrossRefPubMed

23.

Shinkai M, Imano M, Hiraki Y et al (2022) Efficacy of conversion surgery after a single intraperitoneal administration of paclitaxel and systemic chemotherapy for gastric cancer with peritoneal metastasis. Langenbecks Arch Surg 407:975–983. https://doi.org/10.1007/s00423-021-02410-7CrossRefPubMed

Title: Clinical significance of intraperitoneal paclitaxel combined with systemic chemotherapy for gastric cancer with peritoneal metastasis
Authors: Taiki Nakashima
Takaaki Arigami
Yoshikazu Uenosono
Daisuke Matsushita
Masataka Shimonosono
Yusuke Tsuruda
Ken Sasaki
Kenji Baba
Hiroshi Kurahara
Takao Ohtsuka
Publication date: 11-07-2023
Publisher: Springer Nature Singapore
Keywords: Gastric Cancer
Gastric Cancer
Metastasis
Cytostatic Therapy
Published in: International Journal of Clinical Oncology / Issue 10/2023
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-023-02384-0

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2023

Ovarian serous borderline tumors with recurrent or extraovarian lesions: a Japanese, retrospective, multi-institutional, population-based study

Acid suppressants reduce the therapeutic effect of immune checkpoint inhibitors and increase the risk of acute kidney injury: a meta-analysis

Chapter 3: Management of kidney injury caused by cancer drug therapy, from clinical practice guidelines for the management of kidney injury during anticancer drug therapy 2022

Japanese Society of Medical Oncology/Japan Society of Clinical Oncology/Japanese Society of Pediatric Hematology/Oncology-led clinical recommendations on the diagnosis and use of immunotherapy in patients with DNA mismatch repair deficient (dMMR) tumors, third edition

First-line nivolumab plus ipilimumab in metastatic non-small cell lung cancer: 5-year outcomes in Japanese patients from CheckMate 227 Part 1

Tumor immune microenvironment and clinical outcomes in stage IV urothelial cancer: YODO study

Keynote webinar | Spotlight on antibody–drug conjugates in cancer