Oxaliplatin plus S-1 with intraperitoneal paclitaxel for the treatment of Chinese advanced gastric cancer with peritoneal metastases

Min Shi,Sheng Lu,Zhenglun Zhu,Min Yan,Chen Li,Xuexin Yao,Chao Yan,Runhua Feng,Zhentian Ni,Zichen Hua,Wentao Liu,Zhongyin Yang,Jun Zhang,Zhenqiang Wang,Mingmin Chen,Birendra Kumar Sah,Changyu He,Zhenggang Zhu,Yanan Zheng

doi:10.1186/s12885-021-09027-5

Abstract

BackgroundIn this study, we tried to access the efficacy and safety of oxaliplatin plus S-1 with intraperitoneal paclitaxel (PTX) for the treatment of Chinese advanced gastric cancer with peritoneal metastases.Patients and methodsThirty patients diagnosed with advanced gastric cancer underwent laparoscopic exploration and were enrolled when macroscopic disseminated metastases (P1) were confirmed. PTX was diluted in 1 l of normal saline and IP administered through peritoneal port at an initial dose of 40 mg/m2 over 1 h on day1,8, respectively. Oxaliplatin was administered intravenously at an initial dose of 100 mg/m2 on day1, and S-1 was administered orally at an initial dose of 80 mg/m2 for 14 days followed by 7 days rest, repeated by every 3 weeks.ResultsOf all these 30 patients, the median number of cycles was 6 (range 2–16) due to the limitation of hematotoxicity and peripheral neuropathy by oxaliplatin. There were 11 (36.7%) patients received conversion surgery. The median progression free survival (PFS) was 6.6 months (95% CI = 4.7–8.5 months) and the median overall survival (OS) was 15.1 months (95% CI = 12.4–17.8 months). The grade 3–4 hematological toxicities were leucopenia (23.3%), neutropenia (23.3%), anemia (16.7%), and thrombocytopenia (20%), respectively. The grade 3–4 non-hematological toxicities were tolerated, most of which were peripheral sensory neuropathy (40%) due to oxaliplatin, diarrhea (20%), nausea and vomiting (26.7%).ConclusionsSOX+ip PTX regimen was effective in advanced gastric cancer with peritoneal metastasis. Survival time was significantly prolonged by conversion surgery. Grade 3–4 toxicities were uncommon. Large scale clinical trial is necessary to get more evidence to identify its efficacy.Trail registrationChiCTR, ChiCTR-IIR-16009802. Registered 9 November 2016,

Highlights

In this study, we tried to access the efficacy and safety of oxaliplatin plus S-1 with intraperitoneal paclitaxel (PTX) for the treatment of Chinese advanced gastric cancer with peritoneal metastases
SOX+ip PTX regimen was effective in advanced gastric cancer with peritoneal metastasis
Survival time was significantly prolonged by conversion surgery

Summary

Introduction

We tried to access the efficacy and safety of oxaliplatin plus S-1 with intraperitoneal paclitaxel (PTX) for the treatment of Chinese advanced gastric cancer with peritoneal metastases. As China has not yet formed a perfect gastrointestinal tumor screening system, the early diagnosis rate needs to be improved [2], and most patients are in the advanced stage when diagnosed, even with distant metastasis [3, 4]. It was reported that nearly 20% of gastric cancer patients were diagnosed with peritoneal metastasis (PM) before or during operation [5], while more than 50% of gastric cancer patients will have peritoneal metastasis in the future even after radical resection. Peritoneal metastasis is the first cause of death in patients with gastric cancer, whether resectable or unresectable [6,7,8]. A large number of cytokines released during wound healing and angiogenesis factors can be regarded as “nourishment”, which together constitute the microenvironment suitable for the formation of peritoneal metastasis

Methods

Results

Discussion

Conclusion