Intraperitoneal therapy for gastric cancer peritoneal carcinomatosis

ABSTRACT

Introduction

Gastric adenocarcinoma (GAC) is one of the most aggressive malignancies worldwide and has a poor prognosis. Multidisciplinary therapies are used in its treatment, but the prognosis for GAC patients with peritoneal metastases (PM) remains poor and there is no effective established approach.

Areas covered

This review summarizes the results of recent clinical studies and recent advances in the management, including surgery, chemotherapy, targeted therapy, and immunotherapy. In this review, keywords were searched in combination with ‘peritoneal carcinomatosis’ and ‘gastric cancer’ in PubMed, and then studies that evaluated peritoneal carcinomatosis associated with gastric cancer were identified through reading them. Several studies were quoted at second hand. Despite recent advances in therapeutic approaches such as systemic chemotherapy, immunotherapy, intraperitoneal chemotherapy, debulking surgery, thermal hyperthermic intraperitoneal chemotherapy, pressurized intraperitoneal aerosol chemotherapy, immunotherapy, and best supportive therapy, further studies are necessary. This review also summarizes molecular biology of GAC patients with PM.

Expert opinion

Each modality is advancing and some have shown therapeutic effects, but none have become standard treatments that exhibit remarkable effects. To improve the prognosis of GAC patients with PM, large-scale clinical trials and further basic research are required.

KEYWORDS:

• Gastric adenocarcinoma
• peritoneal dissemination
• intraperitoneal therapy

Acknowledgments

The authors would like to thank H. Nikki March from Edanz Group (https://en-author-services.edanzgroup.com/ac) for editing a draft of this manuscript.

Article highlights

• The prognosis of patients with peritoneal metastases (PM) remains dismal and no effective treatment regimen has been established. In order to develop optimal treatment for gastric adenocarcinoma (GAC) patients with PM, the molecular mechanisms driving peritoneal dissemination should be understood.

• Systemic chemotherapy is a major treatment option for patients with PM, however, there is a need to tolerate severe symptoms, such as massive ascites, fatigue, appetite loss, and gastrointestinal obstruction.

• Intraperitoneal chemotherapy was assessed in PHOENIX-GC, a Japanese phase III trial, which failed to show the statistical superiority of intraperitoneal PTX plus systemic chemotherapy.

• Pressurized intraperitoneal aerosol chemotherapy (PIPAC) might be a promising strategy for the treatment of peritoneal metastasis, but so far PIPAC is considered as palliative treatment only. Further evidence is warranted and the results of these trials are required.

Comprehensive treatment consisting of cytoreductive gastrectomy combined with intraperitoneal therapy might be an effective strategy to improve the long-term survival of GAC with PM.

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.

Additional information

Funding

This paper was not funded.