Surgical outcomes for gastric cancer patients with intraperitoneal free cancer cell, but no macroscopic peritoneal metastasis

Objective.We evaluated the efficiency of traditional Chinese herbal medicine (a compound herbal formula for invigorating spleen) as a complementary and alternative therapy for gastric cancer patients with peritoneal metastasis.Methods.Between 2001 and 2012, 93 gastric cancer patients with peritoneal metastasis were enrolled in this study. The effect of traditional Chinese herbal medicine on their long-term outcome was investigated. Kaplan-Meier method was used to assess the difference in survival time, and Cox proportional hazards regression analysis was performed to identify independent prognostic factors.Result.First-line palliative chemotherapy plus traditional Chinese herbal medicine was performed in 47 patients and the other 46 patients received chemotherapy alone. The overall survival was different between patients with and without traditional Chinese herbal medicine (12.0 versus 10.5 months;P=0.046). According to the Cox proportional hazard model, first-line chemotherapy cycle (hazards ratio [HR] = 0.527; 95% CI = 0.323~0.860) and TCHM (hazards ratio [HR] = 0.644; 95% CI = 0.481~0.992) were selected as independent prognostic factors for survival.Conclusion.The results suggest that traditional Chinese herbal medicine could improve the prognosis of the gastric cancer patients with peritoneal metastasis.

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Peritoneal lavage CEA mRNA levels predict conversion gastrectomy outcomes after induction chemotherapy in gastric cancer patients with peritoneal metastasis

Annals of Oncology ◽

10.1093/annonc/mdx369.040 ◽

2017 ◽

Vol 28 ◽

pp. v223

Author(s):

H. Yamaguchi ◽

Y. Sato ◽

H. Ishigami ◽

H. Oozawa ◽

M. Kurihara ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Induction Chemotherapy ◽

Peritoneal Metastasis ◽

Peritoneal Lavage ◽

Mrna Levels ◽

Gastric Cancer Patients ◽

Cea Mrna

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Phase I/II study of a combination of capecitabine, cisplatin, and intraperitoneal docetaxel (XP ID) in advanced gastric cancer patients with peritoneal metastasis

Gastric Cancer ◽

10.1007/s10120-017-0710-0 ◽

2017 ◽

Vol 20 (6) ◽

pp. 970-977 ◽

Cited By ~ 4

Author(s):

Hyungwoo Cho ◽

Min-Hee Ryu ◽

Kyu-pyo Kim ◽

Baek-Yeol Ryoo ◽

Sook Ryun Park ◽

...

Keyword(s):

Gastric Cancer ◽

Phase I ◽

Advanced Gastric Cancer ◽

Cancer Patients ◽

Peritoneal Metastasis ◽

Gastric Cancer Patients

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Phase I study of biweekly intravenous paclitaxel plus intraperitoneal cisplatin and paclitaxel for gastric cancer with peritoneal metastasis.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.139 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 139-139

Author(s):

H. Ishigami ◽

J. Kitayama ◽

S. Kaisaki ◽

H. Yamaguchi ◽

H. Yamashita ◽

...

Keyword(s):

Gastric Cancer ◽

Phase I ◽

Cancer Patients ◽

Dose Level ◽

Peritoneal Metastasis ◽

Phase I Study ◽

Level 1 ◽

Grade 3 ◽

Gastric Cancer Patients ◽

Experienced Grade

139 Background: Intraperitoneal (IP) chemotherapy is promising for the treatment of gastric cancer with peritoneal metastasis. We previously verified the safety and efficacy of IP paclitaxel (PTX) combined with S-1 and intravenous (IV) PTX in phase I and phase II studies (Oncology. 2009; Ann Oncol. 2010). Secondly, we developed a new IP-containing chemotherapy regimen, IV PTX plus IP cisplatin (CDDP) and PTX, for patients who have failed S-1-based chemotherapy. We performed a phase I study to determine the maximum-tolerated dose (MTD) and recommended dose (RD) in gastric cancer patients. Methods: A total of 9 gastric cancer patients were enrolled who had shown progression of peritoneal metastasis after S-1-based chemotherapy. PTX was administered intravenously at a dose of 100 mg/m2 and intraperitoneally over 1 hour with an initial dose of 20 mg/m2 (level 1), stepped up to 30 or 40 mg/m2 depending on observed toxicity. CDDP was subsequently administered intraperitoneally at a dose of 30 mg/m2 over 24 hours after PTX infusion. PTX and CDDP were administered on days 1 and 15 in 4-week cycles. Results: At dose level 1, dose-limiting toxicities (DLTs) were observed in 2 of 3 patients. One patient experienced grade 4 leukopenia, and the other grade 3 vomiting. Because of higher toxicities than anticipated, the initial dose-escalation schedule was abandoned, and the doses of IV PTX and IP CDDP were reduced to 80 mg/m2 and 25 mg/m2, respectively, while keeping the dose of IP PTX at 20 mg/m2 (level 0). At dose level 0, one of the first 3 patients experienced grade 3 nausea, and an additional 3 patients experienced no DLTs. Consequently, the MTD and RD were determined to be dose level 1 and dose level 0, respectively. No patients experienced complications related to the peritoneal access device or IP infusion. Conclusions: Combination chemotherapy of IV PTX plus IP CDDP and PTX was shown to be a safe regimen that should be further explored in clinical trials. No significant financial relationships to disclose.

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Cell-free and Concentrated Ascites Reinfusion Therapy (CART) for management of massive malignant ascites in gastric cancer patients with peritoneal metastasis treated with intravenous and intraperitoneal administration of Paclitaxel with Oral S-1.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.15_suppl.e15042 ◽

2015 ◽

Vol 33 (15_suppl) ◽

pp. e15042-e15042

Author(s):

Joji Kitayama ◽

Hironori Ishigami ◽

Hironori Yamaguchi ◽

Norio Hanafusa

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Peritoneal Metastasis ◽

Intraperitoneal Administration ◽

Malignant Ascites ◽

Gastric Cancer Patients

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Phase II study of intraperitoneal paclitaxel combined with S-1 plus cisplatin for gastric cancer with peritoneal metastasis: SP + IP PTX trial.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.4529 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 4529-4529

Author(s):

Daisuke Kobayashi ◽

Ryoji Fukushima ◽

Mitsuhiko Ota ◽

Sachio Fushida ◽

Naoyuki Yamashita ◽

...

Keyword(s):

Gastric Cancer ◽

Cancer Patients ◽

Phase Ii ◽

Peritoneal Metastasis ◽

Response Rate ◽

Phase Iii ◽

Peritoneal Cytology ◽

Response To Chemotherapy ◽

Grade 3 ◽

Gastric Cancer Patients

4529 Background: Intraperitoneal (IP) chemotherapy is a promising treatment option for gastric cancer with peritoneal metastasis. Although a phase III study failed to show a statistically significant superiority of IP paclitaxel (PTX) combined with S-1 and intravenous PTX over S-1/cisplatin (SP), the standard of care as a first-line treatment in Japan, the sensitivity analysis suggested clinical efficacy of the IP PTX. Thus, attempts to combine IP PTX with other systemic therapies with higher efficacy have been warranted. After a dose-finding study, we sought to explore efficacy of a new regimen that combined IP PTX with SP. Methods: Gastric cancer patients with peritoneal metastasis confirmed by diagnostic imaging, laparoscopy or laparotomy were enrolled in the phase II multi-institutional prospective trial. In addition to the established SP regimen (S-1 administered orally at a dose of 80 mg/m2 bid for 21 days followed by a 14-day rest and cisplatin administered intravenously at a dose of 60 mg/m2 on day 8), IP PTX was administered on days 1, 8 and 22 at a dose of 20 mg/m2. The primary endpoint is overall survival (OS) rate at one year after treatment initiation. Secondary endpoints are progression free survival (PFS), response rate and toxicity. Results: Fifty-three patients were enrolled and fully evaluated for OS and toxicity. The median number of courses was 7 (range 1-20). The 1-year OS rate was 74% (95% CI, 60-83%). The median survival time was 19.4 months (95% CI, 16.7 months-). The 1-year PFS rate was 57% (95% CI, 42-69%). The overall response rate was 20% (95% CI, 1-72%) in 5 patients with target lesions. Cancer cells ceased to be detected by peritoneal cytology in 23 (64%) of 36 patients. Fourteen (26%) patients underwent gastrectomy after response to chemotherapy. The incidences of grade 3/4 hematological and non-hematological toxicities were 43% and 47%, respectively. The frequent grade 3/4 toxicities included neutropenia (23%), anemia (29%), diarrhea (13%) and anorexia (17%). Intraperitoneal catheter and implanted port-related complications were observed in 4 patients. There was 1 treatment-related death. Conclusions: IP PTX combined with SP is well tolerated and active in gastric cancer patients with peritoneal metastasis. Clinical trial information: UMIN000023000 .

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