1
|
Stroobant EE, Strong VE. Advances in Gastric Cancer Surgical Management. Hematol Oncol Clin North Am 2024; 38:547-557. [PMID: 38402138 DOI: 10.1016/j.hoc.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
The goal of a gastric cancer operation is a microscopically negative resection margin and D2 lymphadenectomy. Minimally invasive techniques (laparoscopic and robotic) have been proven to be equivalent for oncologic care, yet with faster recovery. Endoscopic mucosal resection can be used for T1a N0 tumor resection. Better understanding of hereditary gastric cancer and molecular subtypes has led to specialized recommendations for MSI-high tumors and patients with pathogenic CDH1 mutations. In the future, surgical management will support minimally invasive approaches and personalized cancer care based on subtype.
Collapse
Affiliation(s)
- Emily E Stroobant
- Gastric and Mixed Tumor Service, Department of Surgery - H1216, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Vivian E Strong
- Gastric and Mixed Tumor Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Weill Cornell Medical College of Cornell University, 1300 York Avenue, New York, NY, 10065, USA.
| |
Collapse
|
2
|
Kim HD, Ryu MH, Kang YK. Adjuvant treatment for locally advanced gastric cancer: an Asian perspective. Gastric Cancer 2024; 27:439-450. [PMID: 38489111 DOI: 10.1007/s10120-024-01484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/21/2024] [Indexed: 03/17/2024]
Abstract
Standard adjuvant treatment for locally advanced gastric cancer (LAGC) is regionally different. Whereas perioperative chemotherapy is the standard in Western populations, D2 gastrectomy followed by adjuvant chemotherapy has been the standard in East Asia. Recently, the pivotal phase 3 PRODIGY and RESOLVE studies have demonstrated survival benefits of adding neoadjuvant chemotherapy to surgery followed by adjuvant chemotherapy over up-front surgery followed by adjuvant chemotherapy in Asian patients. Based on these results, neoadjuvant chemotherapy is considered one of the viable options for patients with LAGC. In this review, various aspects of neoadjuvant chemotherapy will be discussed for its optimal application in Asia. Candidates for neoadjuvant chemotherapy should be carefully chosen in consideration of the inaccurate aspects of radiological clinical staging and its potential benefit over up-front surgery followed by a decision on adjuvant chemotherapy according to the pathological stage. Efforts should continuously be made to optimally apply neoadjuvant chemotherapy to patients with LAGC, considering various factors, including a more accurate radiological assessment of the tumor burden and the optimization of post-operative chemotherapy. Future neoadjuvant trials involving novel agents for Asian patients should be designed based on proven Asian regimens rather than adopting Western regimens.
Collapse
Affiliation(s)
- Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88,Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88,Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88,Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| |
Collapse
|
3
|
Yamamoto M, Kurino T, Matsuda R, Jones HS, Nakamura Y, Kanamori T, Tsuji AB, Sugyo A, Tsuda R, Matsumoto Y, Sakurai Y, Suzuki H, Sano M, Osada K, Uehara T, Ishii Y, Akita H, Arano Y, Hisaka A, Hatakeyama H. Delivery of aPD-L1 antibody to i.p. tumors via direct penetration by i.p. route: Beyond EPR effect. J Control Release 2022; 352:328-337. [PMID: 36280153 DOI: 10.1016/j.jconrel.2022.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/28/2022] [Accepted: 10/18/2022] [Indexed: 11/08/2022]
Abstract
Chemotherapy for peritoneal dissemination is poorly effective owing to limited drug transfer from the blood to the intraperitoneal (i.p.) compartment after intravenous (i.v.) administration. i.p. chemotherapy has been investigated to improve drug delivery to tumors; however, the efficacy continues to be debated. As anticancer drugs have low molecular weight and are rapidly excreted through the peritoneal blood vessels, maintaining the i.p. concentration as high as expected is a challenge. In this study, we examined whether i.p. administration is an efficient route of administration of high-molecular-weight immune checkpoint inhibitors (ICIs) for the treatment of peritoneal dissemination using a model of peritoneal disseminated carcinoma. After i.p. administration, the amount of anti-PD-L1 antibody transferred into i.p. tumors increased by approximately eight folds compared to that after i.v. administration. Intratumoral distribution analysis revealed that anti-PD-L1 antibodies were delivered directly from the i.p. space to the surface of tumor tissue, and that they deeply penetrated the tumor tissues after i.p. administration; in contrast, after i.v. administration, anti-PD-L1 antibodies were only distributed around blood vessels in tumor tissues via the enhanced permeability and retention (EPR) effect. Owing to the enhanced delivery, the therapeutic efficacy of anti-PD-L1 antibody in the peritoneal dissemination models was also improved after i.p. administration compared to that after i.v. administration. This is the first study to clearly demonstrate an EPR-independent delivery of ICIs to i.p. tumors by which ICIs were delivered in a massive amount to the tumor tissue via direct penetration after i.p. administration.
Collapse
Affiliation(s)
- Mayu Yamamoto
- Laboratory of Clinical Pharmacology and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan; Laboratory of DDS Design and Drug Disposition, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Taiki Kurino
- Laboratory of Clinical Pharmacology and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Reiko Matsuda
- Laboratory of Clinical Pharmacology and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Haleigh Sakura Jones
- Laboratory of Clinical Pharmacology and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Yoshito Nakamura
- Laboratory of Clinical Pharmacology and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Taisei Kanamori
- Laboratory of Clinical Pharmacology and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan; Laboratory of DDS Design and Drug Disposition, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Atushi B Tsuji
- Department of Molecular Imaging and Theranostics, National Institutes for Quantum and Radiological Science and Technology (QST), Chiba 263-8555, Japan
| | - Aya Sugyo
- Department of Molecular Imaging and Theranostics, National Institutes for Quantum and Radiological Science and Technology (QST), Chiba 263-8555, Japan
| | - Ryota Tsuda
- Laboratory of Clinical Pharmacology and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Yui Matsumoto
- Laboratory of Clinical Pharmacology and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Yu Sakurai
- Laboratory of DDS design and Drug Disposition, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan
| | - Hiroyuki Suzuki
- Laboratory of Molecular Imaging and Radiotherapy, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Makoto Sano
- Division of Medical Research Planning and Development, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Kensuke Osada
- Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology (QST), Chiba 263-8555, Japan
| | - Tomoya Uehara
- Laboratory of Molecular Imaging and Radiotherapy, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Yukimoto Ishii
- Division of Medical Research Planning and Development, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Hidetaka Akita
- Laboratory of DDS Design and Drug Disposition, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan; Laboratory of DDS design and Drug Disposition, Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai 980-8578, Japan
| | - Yasushi Arano
- Laboratory of Molecular Imaging and Radiotherapy, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Akihiro Hisaka
- Laboratory of Clinical Pharmacology and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan
| | - Hiroto Hatakeyama
- Laboratory of Clinical Pharmacology and Pharmacometrics, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan; Laboratory of DDS Design and Drug Disposition, Graduate School of Pharmaceutical Sciences, Chiba University, Chiba 260-8675, Japan.
| |
Collapse
|
4
|
Huang B, Rouvelas I, Nilsson M. Gastric and gastroesophageal junction cancer: Risk factors and prophylactic treatments for prevention of peritoneal recurrence after curative intent surgery. Ann Gastroenterol Surg 2022; 6:474-485. [PMID: 35847435 PMCID: PMC9271029 DOI: 10.1002/ags3.12565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/13/2022] [Accepted: 03/01/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Biying Huang
- Department of Upper Abdominal Diseases Karolinska University Hospital Stockholm Sweden
| | - Ioannis Rouvelas
- Department of Upper Abdominal Diseases Karolinska University Hospital Stockholm Sweden
- Division of Surgery Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet Stockholm Sweden
| | - Magnus Nilsson
- Department of Upper Abdominal Diseases Karolinska University Hospital Stockholm Sweden
- Division of Surgery Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institutet Stockholm Sweden
| |
Collapse
|
5
|
Hyperthermic Intraperitoneal Chemotherapy plus Intravenous Chemotherapy of Paclitaxel with or without Sintilimab in Gastric Cancer: A Comparative Study. JOURNAL OF ONCOLOGY 2022; 2022:3054485. [PMID: 35242186 PMCID: PMC8888085 DOI: 10.1155/2022/3054485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/22/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022]
Abstract
Objective To compare the clinical efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) plus intravenous chemotherapy of paclitaxel with or without sintilimab in peritoneal metastasis of gastric cancer. Methods A total of 120 patients assessed for eligibility with peritoneal metastasis of gastric cancer treated in the oncology department of our hospital from January 2019 to June 2020 were recruited. They were concurrently randomly assigned in a 1 : 1 ratio to receive HIPEC plus sintilimab-paclitaxel intravenous chemotherapy (study group) or plus paclitaxel intravenous chemotherapy only (control group). Results The objective remission rate (ORR) of ascites in the study group was significantly higher than that in the control group. Subgroup analysis showed that an age ≤60 years or well-differentiated tumors were associated with better objective remission. After treatment, significantly higher Karnofsky Performance Status (KPS) scores were observed in the study group versus those of the control group. Adverse events reported were comparable between groups. The study group obtained longer 12-month progression-free survival (PFS) and overall survival (OS) than those of the control group. Conclusion On top of HIPEC, intravenous chemotherapy with sintilimab and paclitaxel constitute an effective alternative for patients with peritoneal metastasis of gastric cancer to enhance ascites remission, ameliorate the quality of life, and prolong survival, versus with paclitaxel alone.
Collapse
|
6
|
Sugawara K, Kawaguchi Y, Seto Y, Vauthey JN. Multidisciplinary treatment strategy for locally advanced gastric cancer: A systematic review. Surg Oncol 2021; 38:101599. [PMID: 33991939 DOI: 10.1016/j.suronc.2021.101599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/26/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Multidisciplinary management of patients with locally advanced gastric cancer (LAGC) remains unstandardized worldwide. We performed a systemic review to summarize the advancements, regional differences, and current recommended multidisciplinary treatment strategies for LAGC. METHODS Eligible studies were identified through a comprehensive search of PubMed, Web of Science, Cochrane Library databases and Embase. Phase 3 randomized controlled trials which investigated survival of patients with LAGC who underwent gastrectomy with pre-/perioperative, postoperative chemotherapy, or chemoradiotherapy were included. RESULTS In total, we identified 11 studies of pre-/perioperative chemotherapy, 38 of postoperative chemotherapy, and 14 of chemoradiotherapy. In Europe and the USA, the current standard of care is perioperative chemotherapy for patients with LAGC using the regimen of 5-FU, folinic acid, oxaliplatin and docetaxel (FLOT). In Eastern Asia, upfront gastrectomy and postoperative chemotherapy is commonly used. The S-1 monotherapy or a regimen of capecitabine and oxaliplatin (CapOx) are used for patients with stage II disease, and the CapOx regimen or the S-1 plus docetaxel regimen are recommended for those with stage III Gastric cancer (GC). The addition of postoperative radiotherapy to peri- or postoperative chemotherapy is currently not recommended. Additionally, clinical trials testing targeted therapy and immunotherapy are increasingly performed worldwide. CONCLUSIONS Recent clinical trials showed a survival benefit of peri-over postoperative chemotherapy and chemoradiotherapy. As such, this strategy may have a potential as a global standard for patients with LAGC. Outcome of the ongoing clinical trials is expected to establish the global standard of multidisciplinary treatment strategy in patients with LAGC.
Collapse
Affiliation(s)
- Kotaro Sugawara
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikuni Kawaguchi
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jean-Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
7
|
Dahdaleh FS, Turaga KK. Evolving Treatment Strategies and Outcomes in Advanced Gastric Cancer with Peritoneal Metastasis. Surg Oncol Clin N Am 2018; 27:519-537. [PMID: 29935687 DOI: 10.1016/j.soc.2018.02.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Gastric cancer (GC) has a predilection to metastasize to the peritoneum, denoting a poor prognosis. Treatment strategies available for advanced GC have significantly evolved over time and can be categorized into systemic, regional, and surgical. Although systemic therapies have been the mainstay for the treatment of advanced GC, their ability in achieving long-term survival in patients with peritoneal involvement is modest at best. This article describes advances in combined modality treatment of peritoneal metastases, specifically with an emphasis on peritoneal-directed therapies.
Collapse
Affiliation(s)
- Fadi S Dahdaleh
- Complex General Surgical Oncology, Section of General Surgery/Surgical Oncology, The University of Chicago Medicine, 5841 South Maryland Avenue, Room S214, MC 5094, Chicago, IL 60637, USA
| | - Kiran K Turaga
- The University of Chicago Medicine, Section of General Surgery/Surgical Oncology, 5841 South Maryland Avenue, Room G207, MC 5094, Chicago, IL 60637, USA.
| |
Collapse
|
8
|
Slagter AE, Jansen EPM, van Laarhoven HWM, van Sandick JW, van Grieken NCT, Sikorska K, Cats A, Muller-Timmermans P, Hulshof MCCM, Boot H, Los M, Beerepoot LV, Peters FPJ, Hospers GAP, van Etten B, Hartgrink HH, van Berge Henegouwen MI, Nieuwenhuijzen GAP, van Hillegersberg R, van der Peet DL, Grabsch HI, Verheij M. CRITICS-II: a multicentre randomised phase II trial of neo-adjuvant chemotherapy followed by surgery versus neo-adjuvant chemotherapy and subsequent chemoradiotherapy followed by surgery versus neo-adjuvant chemoradiotherapy followed by surgery in resectable gastric cancer. BMC Cancer 2018; 18:877. [PMID: 30200910 PMCID: PMC6131797 DOI: 10.1186/s12885-018-4770-2] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/22/2018] [Indexed: 12/21/2022] Open
Abstract
Background Although radical surgery remains the cornerstone of cure in resectable gastric cancer, survival remains poor. Current evidence-based (neo)adjuvant strategies have shown to improve outcome, including perioperative chemotherapy, postoperative chemoradiotherapy and postoperative chemotherapy. However, these regimens suffer from poor patient compliance, particularly in the postoperative phase of treatment. The CRITICS-II trial aims to optimize preoperative treatment by comparing three treatment regimens: (1) chemotherapy, (2) chemotherapy followed by chemoradiotherapy and (3) chemoradiotherapy. Methods In this multicentre phase II non-comparative study, patients with clinical stage IB-IIIC (TNM 8th edition) resectable gastric adenocarcinoma are randomised between: (1) 4 cycles of docetaxel+oxaliplatin+capecitabine (DOC), (2) 2 cycles of DOC followed by chemoradiotherapy (45Gy in combination with weekly paclitaxel and carboplatin) or (3) chemoradiotherapy. Primary endpoint is event-free survival, 1 year after randomisation (events are local and/or regional recurrence or progression, distant recurrence, or death from any cause). Secondary endpoints include: toxicity, surgical outcomes, percentage radical (R0) resections, pathological tumour response, disease recurrence, overall survival, and health related quality of life. Exploratory endpoints include translational studies on predictive and prognostic biomarkers. Discussion The aim of this study is to select the most promising among three preoperative treatment arms in patients with resectable gastric adenocarcinoma. This treatment regimen will subsequently be compared with the standard therapy in a phase III trial. Trial registration clinicaltrials.gov NCT02931890; registered 13 October 2016. Date of first enrolment: 21 December 2017.
Collapse
Affiliation(s)
- Astrid E Slagter
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Edwin P M Jansen
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Academic Medical Center Amsterdam, Meibergdreef 9, 1106 AZ, Amsterdam, The Netherlands
| | - Johanna W van Sandick
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Nicole C T van Grieken
- Department of Pathology, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Karolina Sikorska
- Statistical Department, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Annemieke Cats
- Department of Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Pietje Muller-Timmermans
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Maarten C C M Hulshof
- Department of Radiation Oncology, Academic Medical Center Amsterdam, Meibergdreef 9, 1106 AZ, Amsterdam, The Netherlands
| | - Henk Boot
- Department of Gastroenterology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Maartje Los
- Department of Medical Oncology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Laurens V Beerepoot
- Department of Medical Oncology, St. Elisabeth Hospital, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, The Netherlands
| | - Frank P J Peters
- Department of Medical Oncology, Zuyderland Sittard-Geleen, Dr. H. van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Boudewijn van Etten
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Henk H Hartgrink
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Mark I van Berge Henegouwen
- Department of Surgery, Academic Medical Center Amsterdam, Meibergdreef 9, 1106 AZ, Amsterdam, The Netherlands
| | - Grard A P Nieuwenhuijzen
- Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3484 CX, Utrecht, The Netherlands
| | - Donald L van der Peet
- Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Heike I Grabsch
- Department of Pathology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, P Debyelaan 25, 6229 HX, Maastricht, The Netherlands.,Department of Pathology & Tumour Biology, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Marcel Verheij
- Department of Radiation Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| |
Collapse
|
9
|
Ishigami H, Fujiwara Y, Fukushima R, Nashimoto A, Yabusaki H, Imano M, Imamoto H, Kodera Y, Uenosono Y, Amagai K, Kadowaki S, Miwa H, Yamaguchi H, Yamaguchi T, Miyaji T, Kitayama J. 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 2018; 36:1922-1929. [PMID: 29746229 DOI: 10.1200/jco.2018.77.8613] [Citation(s) in RCA: 201] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose Intraperitoneal paclitaxel plus systemic chemotherapy demonstrated promising clinical effects in patients with gastric cancer with peritoneal metastasis. We aimed to verify its superiority over standard systemic chemotherapy in overall survival. Patients and Methods This randomized phase III trial enrolled patients with gastric cancer with peritoneal metastasis who had received no or short-term (< 2 months) chemotherapy. Patients were randomly assigned at a two-to-one ratio to receive intraperitoneal and intravenous paclitaxel plus S-1 (IP; intraperitoneal paclitaxel 20 mg/m2 and intravenous paclitaxel 50 mg/m2 on days 1 and 8 plus S-1 80 mg/m2 per day on days 1 to 14 for a 3-week cycle) or S-1 plus cisplatin (SP; S-1 80 mg/m2 per day on days 1 to 21 plus cisplatin 60 mg/m2 on day 8 for a 5-week cycle), stratified by center, previous chemotherapy, and extent of peritoneal metastasis. The primary end point was overall survival. Secondary end points were response rate, 3-year overall survival rate, and safety. Results We enrolled 183 patients and performed efficacy analyses in 164 eligible patients. Baseline characteristics were balanced between the arms, except that patients in the IP arm had significantly more ascites. The median survival times for the IP and SP arms were 17.7 and 15.2 months, respectively (hazard ratio, 0.72; 95% CI, 0.49 to 1.04; stratified log-rank P = .080). In the sensitivity analysis adjusted for baseline ascites, the hazard ratio was 0.59 (95% CI, 0.39 to 0.87; P = .008). The 3-year overall survival rate was 21.9% (95% CI, 14.9% to 29.9%) in the IP arm and 6.0% (95% CI, 1.6% to 14.9%) in the SP arm. Both regimens were well tolerated. Conclusion This trial failed to show statistical superiority of intraperitoneal paclitaxel plus systemic chemotherapy. However, the exploratory analyses suggested possible clinical benefits of intraperitoneal paclitaxel for gastric cancer.
Collapse
Affiliation(s)
- Hironori Ishigami
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Yoshiyuki Fujiwara
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Ryoji Fukushima
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Atsushi Nashimoto
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Hiroshi Yabusaki
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Motohiro Imano
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Haruhiko Imamoto
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Yasuhiro Kodera
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Yoshikazu Uenosono
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Kenji Amagai
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Shigenori Kadowaki
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Hiroto Miwa
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Hironori Yamaguchi
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Takuhiro Yamaguchi
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Tempei Miyaji
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| | - Joji Kitayama
- Hironori Ishigami and Tempei Miyaji, The University of Tokyo; Ryoji Fukushima, Teikyo University, Tokyo; Yoshiyuki Fujiwara, Osaka International Cancer Institute; Motohiro Imano and Haruhiko Imamoto, Kindai University, Osaka; Atsushi Nashimoto, Nanbugo General Hospital; Hiroshi Yabusaki, Niigata Cancer Center Hospital, Niigata; Yasuhiro Kodera, Nagoya University; Shigenori Kadowaki, Aichi Cancer Center Hospital, Aichi; Yoshikazu Uenosono, Kagoshima University, Kagoshima; Kenji Amagai, Ibaraki Prefectural Central Hospital, Ibaraki; Hiroto Miwa, Hyogo College of Medicine, Hyogo; Hironori Yamaguchi and Joji Kitayama, Jichi Medical University, Tochigi; and Takuhiro Yamaguchi, Tohoku University, Miyagi, Japan
| |
Collapse
|
10
|
Wang PL, Huang JY, Zhu Z, Gong BC, Huang HW, Duan SJ, Xu HM, Liu FN. Development of a risk-scoring system to evaluate the serosal invasion for macroscopic serosal invasion positive gastric cancer patients. Eur J Surg Oncol 2018; 44:600-606. [DOI: 10.1016/j.ejso.2018.01.240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/06/2017] [Accepted: 01/30/2018] [Indexed: 12/22/2022] Open
|
11
|
Haskins IN, Kroh MD, Amdur RL, Ponksy JL, Rodriguez JH, Vaziri K. The Effect of Neoadjuvant Chemoradiation on Anastomotic Leak and Additional 30-Day Morbidity and Mortality in Patients Undergoing Total Gastrectomy for Gastric Cancer. J Gastrointest Surg 2017; 21:1577-1583. [PMID: 28744744 DOI: 10.1007/s11605-017-3496-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/30/2017] [Indexed: 01/31/2023]
Abstract
INTRODUCTION In addition to increased perioperative morbidity, anastomotic leak following gastric resection for gastric cancer can have detrimental effects on overall and disease-free survival. The risk of anastomotic leak following neoadjuvant therapy remains unknown. The purpose of this study is to investigate the association of preoperative chemotherapy and radiation therapy with postoperative anastomotic leak and additional 30-day morbidity and mortality outcomes following total gastrectomy with reconstruction for gastric cancer using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). METHODS Patients who underwent total gastrectomy with reconstruction for gastric cancer from 2005 to 2012 were identified. Within the NSQIP database, anastomotic leak is captured as an organ space infection. The association of preoperative chemotherapy and radiation therapy with anastomotic leak and additional 30-day morbidity and mortality outcomes was investigated using chi-squared analysis, Fisher's exact test, and Student's t test. RESULTS A total of 1135 patients met inclusion criteria; 121 (10.7%) patients underwent preoperative chemotherapy within 30 days of surgery, and 53 (4.7%) patients underwent preoperative radiation therapy within 90 days of surgery. Neither preoperative chemotherapy nor radiation therapy was associated with an increased risk of anastomotic leak (p = 0.12 and p = 0.58, respectively). When compared to patients who did not undergo neoadjuvant therapy, patients who underwent either preoperative chemotherapy or radiation therapy did not experience a higher frequency of 30-day mortality (p = 0.41), cardiac (p = 0.49), wound (p = 0.76), renal (p = 0.13), septic (p = 0.55), or venous thromboembolism (p = 0.19) events and were significantly less likely to experience a pulmonary event (p = 0.02). CONCLUSION Neoadjuvant therapy prior to gastric resection for gastric cancer is not associated with an increased risk of anastomotic leak or other additional short-term morbidity or mortality.
Collapse
Affiliation(s)
- Ivy N Haskins
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
- Department of Surgery, George Washington University, Washington, DC, USA.
| | - Matthew D Kroh
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
- Department of Surgery, George Washington University, Washington, DC, USA
- Department of General Surgery, Cleveland Clinic Foundation-Abu Dhabi, Abu Dhabi, United Arab Emirates
- Lerner College of Medicine, Case Western Reserve, Cleveland, OH, USA
| | - Richard L Amdur
- Department of Surgery, George Washington University, Washington, DC, USA
| | - Jeffrey L Ponksy
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
- Lerner College of Medicine, Case Western Reserve, Cleveland, OH, USA
| | - John H Rodriguez
- Section of Surgical Endoscopy, Department of General Surgery, Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA
| | - Khashayar Vaziri
- Department of Surgery, George Washington University, Washington, DC, USA
| |
Collapse
|
12
|
He Z, Zhao TT, Xu HM, Wang ZN, Xu YY, Song YX, Ni ZR, Xu H, Yin SC, Liu XY, Miao ZF. Efficacy and safety of intraperitoneal chemotherapy in patients with advanced gastric cancer: a cumulative meta-analysis of randomized controlled trials. Oncotarget 2017; 8:81125-81136. [PMID: 29113372 PMCID: PMC5655267 DOI: 10.18632/oncotarget.20818] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 08/23/2017] [Indexed: 01/04/2023] Open
Abstract
Even when a curative gastrectomy is conducted, the majority of advanced gastric cancer patients with invasion die due to peritoneal recurrence. We performed electronic searches to identify randomized controlled trials published through April 2017 evaluating the effect of intraperitoneal chemotherapy (IPC) on survival rates. We included 23 trials reporting data on 2,767 patients with advanced gastric cancer. Overall, we noted that patients who received IPC had a significantly increased 1-year survival rate, and the treatment effect of IPC on 1-year survival was most prominent in studies conducted in Japan or those with a mean age of less than 60 years. IPC was also associated with an increased incidence of 2-year survival rate, but it was not seen to have this effect in studies conducted in China or Australia or with a mean age greater than 60 years. Similarly, IPC associated with a significantly increased 3-year survival rate, but this difference was not detected in studies conducted in Austria or with a mean age greater than 60 years. IPC has no significant effect on the 5-year survival rate. Finally, IPC was associated with a lower risk of recurrence in patients with advanced gastric cancer. The findings of this study suggest that gastric cancer patients who receive IPC associate with increased 1-year, 2-year, and 3-year survival rates, but this does not extend out to a 5-year survival rate. IPC is also shown to play a protective role against the risk of recurrence in patients with advanced gastric cancer.
Collapse
Affiliation(s)
- Zheng He
- Department of Radiation Oncology, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ting-Ting Zhao
- Department of Breast Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Hui-Mian Xu
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhen-Ning Wang
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Ying-Ying Xu
- Department of Breast Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yong-Xi Song
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhong-Ran Ni
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, Liaoning Province, China.,School of Life Science, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Hao Xu
- Department of Medical Oncology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Song-Cheng Yin
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Xing-Yu Liu
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Zhi-Feng Miao
- Department of Surgical Oncology, First Hospital of China Medical University, Shenyang, Liaoning Province, China
| |
Collapse
|
13
|
|
14
|
Feingold PL, Kwong MLM, Davis JL, Rudloff U. Adjuvant intraperitoneal chemotherapy for the treatment of gastric cancer at risk for peritoneal carcinomatosis: A systematic review. J Surg Oncol 2016; 115:192-201. [PMID: 27878811 DOI: 10.1002/jso.24476] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/02/2016] [Indexed: 12/29/2022]
Abstract
The peritoneal surface is a frequent site of recurrence following surgery for gastric cancer. A systematic review and random effect analysis was undertaken to analyze current literature regarding the role of adjuvant intraperitoneal chemotherapy in gastric cancer. While pooled analysis supports the use of adjuvant IP chemotherapy in resectable gastric cancer, maximal benefit occured with intra-operative delivery, and possibly the use of MMC. J. Surg. Oncol. 2017;115:192-201. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Paul L Feingold
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mei Li M Kwong
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jeremy L Davis
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Udo Rudloff
- Thoracic and Gastrointestinal Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
15
|
Shelton J, Lu X, Hollenbaugh JA, Cho JH, Amblard F, Schinazi RF. Metabolism, Biochemical Actions, and Chemical Synthesis of Anticancer Nucleosides, Nucleotides, and Base Analogs. Chem Rev 2016; 116:14379-14455. [PMID: 27960273 DOI: 10.1021/acs.chemrev.6b00209] [Citation(s) in RCA: 234] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Nucleoside, nucleotide, and base analogs have been in the clinic for decades to treat both viral pathogens and neoplasms. More than 20% of patients on anticancer chemotherapy have been treated with one or more of these analogs. This review focuses on the chemical synthesis and biology of anticancer nucleoside, nucleotide, and base analogs that are FDA-approved and in clinical development since 2000. We highlight the cellular biology and clinical biology of analogs, drug resistance mechanisms, and compound specificity towards different cancer types. Furthermore, we explore analog syntheses as well as improved and scale-up syntheses. We conclude with a discussion on what might lie ahead for medicinal chemists, biologists, and physicians as they try to improve analog efficacy through prodrug strategies and drug combinations.
Collapse
Affiliation(s)
- Jadd Shelton
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
| | - Xiao Lu
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
| | - Joseph A Hollenbaugh
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
| | - Jong Hyun Cho
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
| | - Franck Amblard
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
| | - Raymond F Schinazi
- Center for AIDS Research, Laboratory of Biochemical Pharmacology, Department of Pediatrics, Emory University School of Medicine , 1760 Haygood Drive, NE, Atlanta, Georgia 30322, United States
| |
Collapse
|
16
|
|
17
|
Yang S, Feng R, Pan ZC, Jiang T, Xu Q, Chen Q. A Comparison of Intravenous plus Intraperitoneal Chemotherapy with Intravenous Chemotherapy Alone for the Treatment of Gastric Cancer: A Meta-Analysis. Sci Rep 2015. [PMID: 26220081 PMCID: PMC4518228 DOI: 10.1038/srep12538] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We aimed to evaluate the effectiveness and safety of intravenous (IV) plus intraperitoneal (IP) chemotherapy compared to intravenous (IV) chemotherapy alone for patients with gastric cancer. Electronic databases were searched up to June 2013. Two authors independently selected studies, extracted data and assessed the quality of included studies. The GRADE System was adopted to rate the level of evidence. Of 392 citations, five RCTs involving 1072 patients were included. Overall, a significant improvement in in one- and three- and five-year survival rate was observed in the IV plus IP chemotherapy group (3 RCTs, n = 360, RR = 1.10, 95% CI 1.04 to 1.17), (5 RCTs, n = 953, RR = 1.22, 95% CI 1.11 to 1.35) and (3 RCTs, n = 347, RR = 1.42, 95% CI 1.12 to 1.80), respectively. Results supported a significant decrease in the rate of metastases (1 RCT, n = 85, RR = 0.41 95% CI 0.19 to 0.89) and peritoneal recurrence (2 RCTs, n = 297, RR = 0.41, 95% CI 0.26 to 0.62) in the IV plus IP chemotherapy group, however, the incidence of adverse events was increased. For patients with gastric cancer, IV plus IP chemotherapy can improve the overall survival rate and prevent the distant or peritoneal metastases. An increased risk of neutropenia, peripheral edema and neuropathy was observed.
Collapse
Affiliation(s)
- Sheng Yang
- Department of Medical Oncology, Fujian Medical University Union Hospital, Fujian, China.,Teaching and Research Department of Oncology, Union Clinical medical College of Fujian Medical University, Fujian, China.,Fujian Key Laboratory of Translational Cancer Medicine, Fujian, China.,Fujian Medical University Stem Cell Research Institute, Fujian, China
| | - Rui Feng
- Teaching and Research Department of Oncology, Union Clinical medical College of Fujian Medical University, Fujian, China
| | - Zhang-Chi Pan
- Teaching and Research Department of Oncology, Union Clinical medical College of Fujian Medical University, Fujian, China
| | - Tao Jiang
- Teaching and Research Department of Oncology, Union Clinical medical College of Fujian Medical University, Fujian, China
| | - Qian Xu
- Teaching and Research Department of Oncology, Union Clinical medical College of Fujian Medical University, Fujian, China
| | - Qiang Chen
- Department of Medical Oncology, Fujian Medical University Union Hospital, Fujian, China.,Teaching and Research Department of Oncology, Union Clinical medical College of Fujian Medical University, Fujian, China.,Fujian Key Laboratory of Translational Cancer Medicine, Fujian, China.,Fujian Medical University Stem Cell Research Institute, Fujian, China
| |
Collapse
|
18
|
Yoo C, Ryu MH, Park YS, Yoo MW, Park SR, Ryoo BY, Jang SJ, Yook JH, Kim BS, Kang YK. Intraoperatively assessed macroscopic serosal changes in patients with curatively resected advanced gastric cancer: clinical implications for prognosis and peritoneal recurrence. Ann Surg Oncol 2015; 22:2940-7. [PMID: 25605515 DOI: 10.1245/s10434-014-4352-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND This study aimed to validate the prognostic relevance of macroscopic serosal changes in patients with resected gastric cancer. Prospectively collected databases of two multicenter randomized phase III trials of adjuvant chemotherapy were analyzed. METHODS For this study, 655 patients in the control groups of AMC 0101 and 0201 trials were selected. Macroscopic serosal changes were determined according to disruptions in serosal continuity, such as changes in color or nodular texture by the operating surgeon. Correlations with recurrence-free survival (RFS), overall survival (OS), and time to peritoneal recurrence were analyzed. RESULTS Macroscopic serosal changes were identified intraoperatively in 432 patients (66 %) and found to be significantly associated with multifocal or diffuse involvement (p = 0.001), Borrmann type 4 (p = 0.005), advanced pathologic T (p < 0.001), N (p < 0.001), overall stage (p < 0.001), and total gastrectomy (p < 0.001). In multivariate analyses, which included prognostic factors of localized gastric cancer, macroscopic serosal changes were significantly associated with poor RFS [hazard ratio (HR) 2.0; 95 % confidence interval (CI), 1.4-2.7; p < 0.001] and OS (HR 2.1; 95 % CI 1.5-3.0; p < 0.001). The changes also were significantly related to shorter time to peritoneal recurrence (HR 2.9; 95 % CI 1.7-5.0; p < 0.001). CONCLUSIONS Intraoperatively assessed macroscopic serosal changes confer a poor prognosis and increased peritoneal recurrence for patients with curatively resected gastric cancer. Macroscopic assessment of serosal changes may be a useful indicator that allows better risk stratification of patients with resected gastric cancer in terms of prognosis and peritoneal recurrence.
Collapse
Affiliation(s)
- Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Park SR, Kang YK. Perioperative treatments for resectable gastric cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.3.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Sook Ryun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
20
|
Shum H, Rajdev L. Multimodality management of resectable gastric cancer: A review. World J Gastrointest Oncol 2014; 6:393-402. [PMID: 25320655 PMCID: PMC4197430 DOI: 10.4251/wjgo.v6.i10.393] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/01/2014] [Accepted: 09/10/2014] [Indexed: 02/05/2023] Open
Abstract
Adenocarcinoma of the stomach carries a poor prognosis and is the second most common cause of cancer death worldwide. It is recommended that surgical resection with a D1 or a modified D2 gastrectomy (with at least 15 lymph nodes removed for examination) be performed in the United States, though D2 lymphadenectomies should be performed at experienced centers. A D2 lymphadenectomy is the recommended procedure in Asia. Although surgical resection is considered the definitive treatment, rates of recurrences are high, necessitating the need for neoadjuvant or adjuvant therapy. This review article aims to outline and summarize some of the pivotal trials that have defined optimal treatment options for non-metastatic non-cardia gastric cancer. Some of the most notable trials include the INT-0116 trial, which established a benefit in concurrent chemoradiation and adjuvant chemotherapy. This was again confirmed in the ARTIST trial, especially in patients with nodal involvement. Later, the Medical Research Council Adjuvant Gastric Infusional Chemotherapy trial provided evidence for the use of perioperative chemotherapy. Targeted agents such as ramucirumab and trastuzumab are also being investigated for use in locally advanced gastric cancers after demonstrating a benefit in the metastatic setting. Given the poor response rate of this difficult disease to various treatment modalities, numerous studies are currently ongoing in an attempt to define a more effective therapy, some of which are briefly introduced in this review as well.
Collapse
|