Abstract 1407P
Background
We have shown promising results of intraperitoneal (ip) paclitaxel (PTX) in combination with systemic chemotherapy for gastric cancer (GC) with peritoneal metastases (PM) at the ESMO annual meeting in 2020 (Abstract 1535P). Of 157 patients (pts), median survival time (MST) was 13.5, and 36.8 mos. for 32 conversion surgery cases. ipPTX could provide significantly longer survival for GC pts with PM than conventional chemotherapy, and there were even several patients with the potential to be cured eventually. We analyzed patterns of aggravation and death in pts who underwent ipPTX to achieve better understanding of the disease and its potential outcomes.
Methods
We excluded cases with metastases other than peritoneal. There were GC 107 pts with PM only that received ipPTX from Feb 2013 to Dec 2020. 64 pts had the primary lesion and 43 pts underwent gastrectomy before ipPTX; their MST was 21.9 and 15.3 mos., respectively.
Results
83 (78%) out of 107 pts had aggravation. The most frequent site was the peritoneum, 52 pts. 68 pts (64%) died. 38 pts of these deaths were related to PM. 7 pts died of meningitis carcinomatosa. 32 pts out of 64 achieved conversion surgery, their MST was 36.8 mos. Out of the 32 pts, 21 (66%) recurred, which 16 pts related to PM and 1 to meningitis carsinomatosa. 16 pts (50%) died.
Conclusions
ipPTX in combination with systemic chemotherapy provided significantly longer survival than conventional chemotherapy for GC with PM. However, the majority of patients, including the conversion surgery cases, recurred and eventually died due to reaggravated peritoneal metastases. There were mainly two patterns of aggravation, one was resistance to ipPTX which caused multiple intestinal stenosis or obstruction, the other was limited distribution of ipPTX which in time allows for development of extra peritoneal metastases, causing mostly meningitis and rectal stenosis.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.