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Safety and efficacy of cell-free and concentrated ascites reinfusion therapy (CART) in gastrointestinal cancer patients with massive ascites treated with systemic chemotherapy

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Abstract

Purpose

Gastrointestinal cancer is frequently associated with malignant ascites, resulting in poor prognosis. While cell-free and concentrated ascites reinfusion therapy (CART) improves ascites-related symptoms, its clinical impact in combination with systemic chemotherapy is unclear. The purpose of this study was to evaluate the safety and efficacy of CART in gastrointestinal cancer patients with massive ascites treated with chemotherapy.

Methods

We retrospectively reviewed the medical records of gastrointestinal cancer patients with massive ascites who received CART and chemotherapy at our hospital between July 2015 and September 2017.

Results

A total of 30 patients received CART and chemotherapy: gastric cancer (n = 21) and colorectal cancer (n = 9). The initial CART improved performance status in 20% of the patients, and the mean serum albumin and creatinine was significantly improved. Median time to treatment failure and overall survival of chemotherapy following CART were 2.1 and 3.5 months in gastric cancer patients and 5.8 and 5.8 months in colorectal cancer patients, respectively. The frequency of paracentesis was decreased after introduction of CART followed by chemotherapy in 83% of gastric cancer and in all colorectal cancer patients who had received paracentesis before the initial CART. There were no grade 3/4 adverse events during the CART procedure. Grade 3/4 hematotoxic and non-hematotoxic adverse events of chemotherapy following CART were 30% and less than 10%, respectively.

Conclusions

The combination of CART followed by chemotherapy is safe and could be a treatment option for gastrointestinal cancer patients with massive ascites.

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Acknowledgments

We would like to express our sincere thanks to all patients and investigators.

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Authors and Affiliations

  1. Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Yusuke Nagata, Ken Kato, Takahiro Miyamoto, Hidekazu Hirano, Hirokazu Shoji, Satoru Iwasa, Yoshitaka Honma, Atsuo Takashima, Tetsuya Hamaguchi & Narikazu Boku

  2. Division of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan

    Hiromichi Matsushita

  3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, 105-8471, Japan

    Yusuke Nagata & Masayuki Saruta

  4. Research Center for Medical and Health Data Science, The Institute of Statistical Mathematics, Tokyo, Japan

    Kengo Nagashima

Authors
  1. Yusuke Nagata
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  2. Ken Kato
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  3. Takahiro Miyamoto
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  4. Hidekazu Hirano
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  5. Hirokazu Shoji
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  6. Satoru Iwasa
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  7. Yoshitaka Honma
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  8. Atsuo Takashima
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  9. Tetsuya Hamaguchi
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  10. Hiromichi Matsushita
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  11. Kengo Nagashima
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  12. Masayuki Saruta
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  13. Narikazu Boku
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Corresponding author

Correspondence to Ken Kato.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was reviewed and approved by the Institutional Review Board in National Cancer Center Hospital in Japan, number 2017-229. The Institutional Review Board decided that individual written or verbal consent could be waived because of the retrospective and observational nature of the current study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Nagata, Y., Kato, K., Miyamoto, T. et al. Safety and efficacy of cell-free and concentrated ascites reinfusion therapy (CART) in gastrointestinal cancer patients with massive ascites treated with systemic chemotherapy. Support Care Cancer 28, 5861–5869 (2020). https://doi.org/10.1007/s00520-020-05401-4

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  • DOI: https://doi.org/10.1007/s00520-020-05401-4

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