Peritoneal carcinomatosis with intraperitoneal immunotherapy: current treatment options and perspectives

ABSTRACT

Introduction

Peritoneal carcinomatosis (PC) is an advanced malignancy that is not sensitive to systemic conventional chemotherapy. Treatment options for PC are usually palliative rather than curative. Cytoreductive surgery and hyperthermic intraperitoneal (IP) chemotherapy are associated with limited efficacy in patients with PC. However, the peritoneum can produce effective immunity by inducing T-lymphocyte recruitment and proliferation, and the unique immune environment of the peritoneum provides the rationale for IP immunotherapy in PC.

Areas covered

The authors retrieved relevant documents of IP immunotherapy for PC from PubMed and Medline. This review elaborates on the knowledge of the peritoneal immune microenvironment and IP immunotherapy for PC covering immune stimulators, radioimmunotherapy, catumaxomab, cancer vaccines, chimeric antigen receptor (CAR)-T cells, and immune checkpoint inhibitors.

Expert opinion

The prognosis of PC is poor. However, the peritoneal cavity is a unique immune compartment with abundant immune cells which can produce effective immunity. IP immunotherapy may be a promising strategy in patients with PC.

KEYWORDS:

• Peritoneal carcinomatosis
• peritoneal metastasis
• immune microenvironment
• intraperitoneal treatment
• immunotherapy

Article highlights

• Peritoneal carcinomatosis (PC) is an advanced malignancy that is not sensitive to systemic conventional chemotherapy. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are associated with limited efficacy in patients with PC.

• The peritoneal immune microenvironment consists of various components, including extracellular matrix, endothelial cells, fibroblasts, lymphocytes, adipocytes, abundant dendritic cells, macrophages, and natural killer cells, and a high ratio of CD8+ T cells to CD4+ T cells.

• The peritoneum can produce effective immunity by inducing T-lymphocyte recruitment and proliferation, which provides the rationale for PC immunotherapy.

• Various IP immunotherapy types have been used in preclinical or clinical studies, including immune stimulators, radioimmunotherapy, catumaxomab, cancer vaccines, chimeric antigen receptor (CAR)-T cells, and immune checkpoint inhibitors.

• Some IP immunotherapy was associated with improved survival in treating patients with PC, indicating promising developments of IP immunotherapy in this intractable tumor.

• The possibilities of IP delivery of immune checkpoint inhibitors plus other treatments should be further explored in the future.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Gui-Xia Wei collected data, reviewed the literature, and wrote the manuscript. Yang Du collected data and wrote and revised the manuscript. Yu-Wen Zhou and Lin-Juan Li assisted in drawing. Meng Qiu designed and revised the manuscript. All authors contributed to the article and approved the submitted version.

Additional information

Funding

This paper was funded by the 1·3·5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYJC21017).