Systemic Chemotherapy Including Ramucirumab in Combination With Pressurized Intra-Peritoneal Aerosol Chemotherapy Is a Safe Treatment Option for Peritoneal Metastasis of Gastric Cancer.

Linda Feldbrügge,Andreas Brandl,Alan Oeff,Peter Thuss-Patience,Beate Rau,Timo Alexander Auer,Johann Pratschke,Felix Gronau

doi:10.3389/fonc.2020.610572

Abstract

BackgroundPressurized intraperitoneal aerosol chemotherapy (PIPAC) is a laparoscopic technique for local chemotherapy. It has been used for treatment of peritoneal metastasis of gastric cancer (PM GC) in combination with systemic therapy. VEGFR2 antagonist ramucirumab is a second-line therapy for GC, and has been suspected to cause wound healing disorders.MethodsThis is a retrospective single center cohort study of patients with PM GC, who received PIPAC treatment in combination with systemic chemotherapy with and without ramucirumab. Data on patients’ characteristics and their perioperative courses were collected and complication rates were compared with regard to preoperative use of ramucirumab and time between last dose of systemic therapy and PIPAC treatment.ResultsFifty patients underwent 90 PIPAC treatments for PM GC in 3 years. Overall postoperative morbidity was 11% with 6% severe complications. The mean interval between systemic therapy and PIPAC was 20 days. Neither the length of interval nor the use of ramucirumab had an effect on complication rates.ConclusionOur study suggests that addition of ramucirumab to pre-PIPAC systemic therapy, irrespective of the length of the treatment-free interval before PIPAC, does not increase the risk of postoperative complications and is therefore a safe option for treatment of PM GC.

Highlights

Its incidence slowly decreases in Western countries, gastric cancer (GC) still remains the third most frequent cancer related cause of death worldwide [1]
Studies suggest that a careful patient selection is fundamental, and only patients with a limited peritoneal tumor spread, defined as a peritoneal cancer index (PCI) of under 6–12, may benefit from cytoreductive surgery (CRS) including gastrectomy and peritonectomy [10, 11]
The purpose of this study is to determine the safety of PIPAC surgery following vascular endothelial growth factor receptor 2 (VEGFR2) antagonist ramucirumab containing chemotherapy as a second line treatment for peritoneal metastasis of gastric cancer

Summary

Introduction

Its incidence slowly decreases in Western countries, gastric cancer (GC) still remains the third most frequent cancer related cause of death worldwide [1]. PM of gastric origin is associated with poor median survival rates of only 3 to 7 months without treatment [3, 4] and represents cause of death in 60% of GC patients [5]. Gastrectomy in a multimodal treatment strategy with perioperative chemotherapy is a curative treatment option for patients with locally advanced GC, including those with limited PM, in selected cases [6,7,8]. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a laparoscopic technique for local chemotherapy. It has been used for treatment of peritoneal metastasis of gastric cancer (PM GC) in combination with systemic therapy. VEGFR2 antagonist ramucirumab is a second-line therapy for GC, and has been suspected to cause wound healing disorders

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Conclusion