Skip to main content

Advertisement

SpringerLink
Log in

Treatment strategies for gastric cancer patients with peritoneal metastasis

  • Review Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Although the treatment of gastric cancer improves the clinical outcomes, the survival of gastric cancer patients with peritoneal metastasis is still very poor. Effective drugs against peritoneal metastasis, coupled with new therapeutic modalities, are needed to improve the prognoses of these patients. Paclitaxel and TS-1 are candidate drugs for peritoneal metastasis, and intraperitoneal chemotherapy and targeted therapy are potential new therapeutic modalities. Two phase II studies using TS-1 and intraperitoneal and systemic paclitaxel for gastric cancer patients with peritoneal metastasis showed respectable survival results. In addition, peritoneal metastatic lesions showed high levels of epithelial cellular adhesion molecule (ECAM) and very low levels of human epidermal growth factor receptor 2 (HER2), thus indicating that an anti-ECAM monoclonal antibody, catumaxomab, would be effective against gastric cancer-derived peritoneal metastasis. Although catumaxomab and intraperitoneally administered paclitaxel are not generally used in Japan at present, these treatment strategies might therefore be effectively used in Japan in the near future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Siewert JR, Bottcher K, Roder JD, Busch R, Hermanek P, Meyer HJ. Prognostic relevance of systematic lymph node dissection in gastric carcinoma. German Gastric Carcinoma Study Group. Br J Surg. 1993;80(8):1015–8.

    Article  CAS  PubMed  Google Scholar 

  2. Fujii M, Kochi M, Takayama T. Recent advances in chemotherapy for advanced gastric cancer in Japan. Surg Today. 2010;40(4):295–300. doi:10.1007/s00595-009-4148-9.

    Article  CAS  PubMed  Google Scholar 

  3. Deng J, Liang H, Wang D, Sun D, Pan Y, Liu Y. Investigation of the recurrence patterns of gastric cancer following a curative resection. Surg Today. 2011;41(2):210–5. doi:10.1007/s00595-009-4251-y.

    Article  PubMed  Google Scholar 

  4. Allum WH, Fielding JW. Gastric cancer: a 25-year review. Br J Surg. 1990;77(3):353.

    Article  CAS  PubMed  Google Scholar 

  5. Sugarbaker PH, Yonemura Y. Clinical pathway for the management of resectable gastric cancer with peritoneal seeding: best palliation with a ray of hope for cure. Oncology. 2000;58(2):96–107 ([pii] 12086).

    Article  CAS  PubMed  Google Scholar 

  6. Fujimoto S, Takahashi M, Kobayashi K, Kure M, Mutou T, Masaoka H, Ohkubo H. Relation between clinical and histologic outcome of intraperitoneal hyperthermic perfusion for patients with gastric cancer and peritoneal metastasis. Oncology. 1993;50(5):338–43.

    Article  CAS  PubMed  Google Scholar 

  7. Ajani JA. Standard chemotherapy for gastric carcinoma: is it a myth? J Clin Oncol. 2000;18(23):4001–3.

    CAS  PubMed  Google Scholar 

  8. Fujii M, Kim YH, Satoh T, Hosaka H, T. Kim, Tsuji A, Inokuchi M, Takagane A, Oh SC, Tanabe K, Okuno T, Chin K, Ura T, Lee JI, Kakudo Y, Yamaguchi K, Iijima S, Takeuchi M, Kim H, Nakajima T. Randomized phase III study of S-1 alone versus S-1 plus docetaxel (DOC) in the treatment for advanced gastric cancer (AGC): the START trial update. J Clin Oncol 2011;29 (suppl; abstr 4016).

    Google Scholar 

  9. Shirao K, Boku N, Yamada Y, Yamaguchi K, Doi Y, Takiuchi H, Nasu J, Nakamura K, Fukuda H, Ohtsu A. Randomized phase III study of 5-fluorouracil continuous infusion (5FU ci) versus methotrexate and 5-FU sequential therapy (MF) in gastric cancer with peritoneal metastasis (JCOG0106).escalating single-dose and weekly fixed-dose study of cetuximab pharmacokinetics in Japanese patients with solid tumors. J Clin Oncol 2009;27(15s):suppl; abst 4545.

  10. Takiuchi H, H. F, Boku N, Shimada Y, Nasu J, Hamamoto Y, Hironaka S, Yamaguchi K, Takashima A, Ohtsu A. Randomized phase II study of best-available 5-fluorouracil (5-FU) versus weekly paclitaxel in gastric cancer (GC) with peritoneal metastasis (PM) refractory to 5-FU-containing regimens (JCOG0407). J Clin Oncol 2010;28(15s):suppl; abstr 4052.

  11. Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, Miyashita K, Nishizaki T, Kobayashi O, Takiyama W, Toh Y, Nagaie T, Takagi S, Yamamura Y, Yanaoka K, Orita H, Takeuchi M. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008;9(3):215–21. doi:10.1016/S1470-2045(08)70035-4.

    Article  CAS  PubMed  Google Scholar 

  12. Shirasaka T, Shimamato Y, Ohshimo H, Yamaguchi M, Kato T, Yonekura K, Fukushima M. Development of a novel form of an oral 5-Fluorouracil derivative (S-1) directed to the potentiation of the tumor selective cytotoxicity of 5-Fluorouracil by two biochemical modulators. Anticancer Drugs. 1996;7(5):548–57.

    Article  CAS  PubMed  Google Scholar 

  13. Boku N. Chemotherapy for metastatic disease: review from JCOG trials. Int J Clin Oncol. 2008;13(3):196–200. doi:10.1007/s10147-008-0784-0.

    Article  CAS  PubMed  Google Scholar 

  14. Kodera Y, Ito S, Mochizuki Y, Fujitake S, Koshikawa K, Kanyama Y, Matsui T, Kojima H, Takase T, Ohashi N, Fujiwara M, Sakamoto J, Akimasa N. A phase II study of weekly paclitaxel as second-line chemotherapy for advanced gastric Cancer (CCOG0302 study). Anticancer Res. 2007;27(4C):2667–71.

    CAS  PubMed  Google Scholar 

  15. Cascinu S, Graziano F, Cardarelli N, Marcellini M, Giordani P, Menichetti ET, Catalano G. Phase II study of paclitaxel in pretreated advanced gastric cancer. Anticancer Drugs. 1998;9(4):307–10.

    Article  CAS  PubMed  Google Scholar 

  16. Emi Y, Yamamoto M, Takahashi I, Orita H, Kakeji Y, Kohnoe S, Maehara Y. Phase II study of weekly paclitaxel by one-hour infusion for advanced gastric cancer. Surg Today. 2008;38(11):1013–20. doi:10.1007/s00595-008-3769-8.

    Article  CAS  PubMed  Google Scholar 

  17. Mori T, Fujiwara Y, Yano M, Tamura S, Yasuda T, Takiguchi S, Monden M. Prevention of peritoneal metastasis of human gastric cancer cells in nude mice by S-1, a novel oral derivative of 5-Fluorouracil. Oncology. 2003;64(2):176–82 ([pii] 67774).

    Article  CAS  PubMed  Google Scholar 

  18. Kobayashi M, Sakamoto J, Namikawa T, Okamoto K, Okabayashi T, Ichikawa K, Araki K. Pharmacokinetic study of paclitaxel in malignant ascites from advanced gastric cancer patients. World J Gastroenterol. 2006;12(9):1412–5.

    CAS  PubMed  Google Scholar 

  19. Narahara H, Fujitani K, Takiuchi H, Sugimoto N, Inoue K, Uedo N, Tsukuma H, Tsujinaka T, Furukawa H, Taguchi T. Phase II study of a combination of S-1 and paclitaxel in patients with unresectable or metastatic gastric cancer. Oncology. 2008;74(1–2):37–41. doi:10.1159/000138978.

    Article  CAS  PubMed  Google Scholar 

  20. Mochiki E, Ohno T, Kamiyama Y, Aihara R, Haga N, Ojima H, Nakamura J, Ohsawa H, Nakabayashi T, Takeuchi K, Asao T, Kuwano H. Phase I/II study of S-1 combined with paclitaxel in patients with unresectable and/or recurrent advanced gastric cancer. Br J Cancer. 2006;95(12):1642–7. doi:10.1038/sj.bjc.6603497.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  21. Imano M, Peng YF, Itoh T, Nishikawa M, Satou T, Yasuda A, Inoue K, Kato H, Shinkai M, Tsubaki M, Yasuda T, Imamoto H, Nishida S, Furukawa H, Takeyama Y, Okuno K, Shiozaki H. A preliminary study of single intraperitoneal administration of paclitaxel followed by sequential systemic chemotherapy with S-1 plus paclitaxel for advanced gastric cancer with peritoneal metastasis. Anticancer Res. 2012;32(9):4071–5 ([pii] 32/9/4071).

    CAS  PubMed  Google Scholar 

  22. Markman M, Rowinsky E, Hakes T, Reichman B, Jones W, Lewis JL Jr, Rubin S, Curtin J, Barakat R, Phillips M, et al. Phase I trial of intraperitoneal taxol: a Gynecoloic Oncology Group study. J Clin Oncol. 1992;10(9):1485–91.

    CAS  PubMed  Google Scholar 

  23. Imano M, Imamoto H, Itoh T, Satou T, Peng YF, Yasuda A, Kato H, Shiraishi O, Shinkai M, Yasuda T, Takeyama Y, Okuno K, Shiozaki H. Safety of intraperitoneal administration of paclitaxel after gastrectomy with en-bloc D2 lymph node dissection. J Surg Oncol. 2012;105(1):43–7. doi:10.1002/jso.22065.

    Article  CAS  PubMed  Google Scholar 

  24. Soma D, Kitayama J, Konno T, Ishihara K, Yamada J, Kamei T, Ishigami H, Kaisaki S, Nagawa H. Intraperitoneal administration of paclitaxel solubilized with poly(2-methacryloxyethyl phosphorylcholine-co n-butyl methacrylate) for peritoneal dissemination of gastric cancer. Cancer Sci. 2009;100(10):1979–85. doi:10.1111/j.1349-7006.2009.01265.x.

    Article  CAS  PubMed  Google Scholar 

  25. Kyle AH, Huxham LA, Yeoman DM, Minchinton AI. Limited tissue penetration of taxanes: a mechanism for resistance in solid tumors. Clin Cancer Res. 2007;13(9):2804–10. doi:10.1158/1078-0432.CCR-06-1941.

    Article  CAS  PubMed  Google Scholar 

  26. Imano M, Yasuda A, Itoh T, Satou T, Peng YF, Kato H, Shinkai M, Tsubaki M, Chiba Y, Yasuda T, Imamoto H, Nishida S, Takeyama Y, Okuno K, Furukawa H, Shiozaki H. Phase II study of single intraperitoneal chemotherapy followed by systemic chemotherapy for gastric cancer with peritoneal metastasis. J Gastrointest Surg. 2012;. doi:10.1007/s11605-012-2059-3.

    PubMed  Google Scholar 

  27. Ishigami H, Kitayama J, Kaisaki S, Hidemura A, Kato M, Otani K, Kamei T, Soma D, Miyato H, Yamashita H, Nagawa H. Phase II study of weekly intravenous and intraperitoneal paclitaxel combined with S-1 for advanced gastric cancer with peritoneal metastasis. Ann Oncol. 2010;21(1):67–70. doi:10.1093/annonc/mdp260.

    Article  CAS  PubMed  Google Scholar 

  28. Sadeghi B, Arvieux C, Glehen O, Beaujard AC, Rivoire M, Baulieux J, Fontaumard E, Brachet A, Caillot JL, Faure JL, Porcheron J, Peix JL, Francois Y, Vignal J, Gilly FN. Peritoneal carcinomatosis from non-gynecologic malignancies: results of the EVOCAPE 1 multicentric prospective study. Cancer. 2000;88(2):358–63. doi:10.1002/(SICI)1097-0142(20000115)88:2<358:AID-CNCR16>3.0.CO;2-O.

    Article  CAS  PubMed  Google Scholar 

  29. Fujiwara Y, Takiguchi S, Nakajima K, Miyata H, Yamasaki M, Kurokawa Y, Mori M, Doki Y. Intraperitoneal docetaxel combined with S-1 for advanced gastric cancer with peritoneal dissemination. J Surg Oncol. 2012;105:38–42. doi:10.1002/jso.22057.

    Article  CAS  PubMed  Google Scholar 

  30. Morgan RJ Jr, Doroshow JH, Synold T, Lim D, Shibata S, Margolin K, Schwarz R, Leong L, Somlo G, Twardowski P, Yen Y, Chow W, Lin P, Paz B, Chu D, Frankel P, Stalter S. Phase I trial of intraperitoneal docetaxel in the treatment of advanced malignancies primarily confined to the peritoneal cavity: dose-limiting toxicity and pharmacokinetics. Clin Cancer Res. 2003;9(16 Pt 1):5896–901.

    CAS  PubMed  Google Scholar 

  31. Fushida S, Kinoshita J, Yagi Y, Funaki H, Kinami S, Ninomiya I, Fujimura T, Nishimura G, Kayahara M, Ohta T. Dual anti-cancer effects of weekly intraperitoneal docetaxel in treatment of advanced gastric cancer patients with peritoneal carcinomatosis: a feasibility and pharmacokinetic study. Oncol Rep. 2008;19(5):1305–10.

    CAS  PubMed  Google Scholar 

  32. Kodera Y, Imano M, Yoshikawa T, Takahashi N, Tsuburaya A, Miyashita Y, Morita S, Nakao A, Sakamoto J, Sasako M. A randomized phase II trial to test the efficacy of intra-peritoneal paclitaxel for gastric cancer with high risk for the peritoneal metastasis (INPACT trial). Jpn J Clin Oncol. 2011;41(2):283–6. doi:10.1093/jjco/hyq187.

    Article  PubMed  Google Scholar 

  33. Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, Lordick F, Ohtsu A, Omuro Y, Satoh T, Aprile G, Kulikov E, Hill J, Lehle M, Ruschoff J, Kang YK. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010;376(9742):687–97. doi:10.1016/S0140-6736(10)61121-X.

    Article  CAS  PubMed  Google Scholar 

  34. Imano M, Satou T, Itoh T, Yasuda A, Kato H, Shinkai M, Peng YF, Tsubaki M, Yasuda T, Imamoto H, Nishida S, Takeyama Y, Okuno K, Shiozaki H. Peritoneal metastatic lesions of gastric cancer exhibit low expression of human epidermal growth factor receptor 2. Target Oncol. 2012;. doi:10.1007/s11523-012-0223-z.

    Google Scholar 

  35. Kunz PL, Mojtahed A, Fisher GA, Ford JM, Chang DT, Balise RR, Bangs CD, Cherry AM, Pai RK. HER2 expression in gastric and gastroesophageal junction adenocarcinoma in a US population: clinicopathologic analysis with proposed approach to HER2 assessment. Appl Immunohistochem Mol Morphol. 2012;20(1):13–24. doi:10.1097/PAI.0b013e31821c821c.

    Article  CAS  PubMed  Google Scholar 

  36. Heiss MM, Murawa P, Koralewski P, Kutarska E, Kolesnik OO, Ivanchenko VV, Dudnichenko AS, Aleknaviciene B, Razbadauskas A, Gore M, Ganea-Motan E, Ciuleanu T, Wimberger P, Schmittel A, Schmalfeldt B, Burges A, Bokemeyer C, Lindhofer H, Lahr A, Parsons SL. The trifunctional antibody catumaxomab for the treatment of malignant ascites due to epithelial cancer: results of a prospective randomized phase II/III trial. Int J Cancer. 2010;127(9):2209–21. doi:10.1002/ijc.25423.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  37. Imano M, Itoh T, Satou T, Yasuda A, Nishiki K, Kato H, Shiraishi O, Peng YF, Shinkai M, Tsubaki M, Yasuda T, Imamoto H, Nishida S, Takeyama Y, Furkawa H, Okuno K, Shiozaki H. High expression of epithelial cellular adhesion molecule in peritoneal metastasis of gastric cancer. Target Oncol. 2012;. doi:10.1007/s11523-012-0239-4.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgery Department, Kinki University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    Motohiro Imano & Kiyotaka Okuno

  2. Cancer Center, Kinki University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    Motohiro Imano

Authors
  1. Motohiro Imano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kiyotaka Okuno
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Motohiro Imano.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Imano, M., Okuno, K. Treatment strategies for gastric cancer patients with peritoneal metastasis. Surg Today 44, 399–404 (2014). https://doi.org/10.1007/s00595-013-0603-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-013-0603-8

Keywords

Search

Navigation