Intraperitoneal administration of paclitaxel and oral S-1 for a patient with peritoneal dissemination and hydronephrosis due to advanced gastric cancer

Abstract

S-1 has been developed in Japan as an oral anticancer drug, composed of tegafur, 5-chloro-2, 4-dihydroxypyridine (gimeracil), and monopotassium 1, 2, 3, 4-tetrahydro-2, 4-dioxo-1, 3, 5-triazine-6-carboxylate (oteracil), based on the biological modulation of 5-fl uorouracil (FU) [5]. Japanese late phase II trials of S-1 in gastric cancer have shown overall response rates of up to 49% and a median survival period of 8 months [6,7]. We have demonstrated that S-1 has a larger area under the curve 5-FU for peritoneal dissemination and ascites than for plasma [8], and thus S-1 might be effective for prolonging the survival of gastric cancer patients with peritoneal metastasis.Paclitaxel is a cytotoxic antineoplastic agent that results in tumor cell death by causing the excessive polymerization of tubulin and microtubule dysfunction [9]. The large molecular weight and bulky chemical structure of paclitaxel delay its peritoneal clearance [10] and increase exposure in the peritoneal cavity, and thus it can be exploited in the treatment of gastric cancer with peritoneal dissemination.We report a gastric cancer patient with peritoneal dissemination and hydronephrosis who was successfully treated with intraperitoneal infusion of paclitaxel and oral administration of S-1. Case reportA 34-year-old man was treated with an H2-blocker antagonist for about 6 months for a chief complaint of upper abdominal discomfort, suggesting the possibility of duodenal ulcer. Because his condition did not improve, he underwent endoscopic examination at another clinic. He was diagnosed as having type 3 advanced gastric cancer on the greater curvature of the gastric body by upper gastrointestinal (UGI) and endoscopic examination. He was referred to a hospital for surgical resection. An abdominal computed tomogra- AbstractWe report a patient with type 3 gastric cancer with peritoneal dissemination and hydronephrosis who was successfully treated with intraperitoneal infusion of paclitaxel and oral administration of S-1. He was diagnosed with unresectable gastric cancer with severe peritoneal dissemination by staging laparoscopy. We selected combined chemotherapy with both paclitaxel and S-1. Paclitaxel at 60 mg/m 2 was administered intraperitoneally on days 1 and 8, and S-1 at 100 mg/body was administered orally for 14 days, followed by 7 days' rest, as one course. After fi ve courses, primary tumor reduction was confi rmed and no cancer cells were detected on pathocytological investigation at second-look laparoscopy. The patient underwent total gastrectomy with lymph node dissection. He died from liver metastasis 29 months after the initial treatment, but he had not suffered from peritoneal metastases and had kept a good quality of life (QOL) since that treatment. This chemotherapy can be applied as one of the promising candidates for the treatment of patients with peritoneal metastasis of gastric cancer.

Clinical Outcome and Management of Ureteral Obstruction Secondary to Gastric Cancer

“…Limited reports suggest a potential survival benefit of chemotherapy for patients with ureteral obstruction secondary to gastric cancer [17]. The median survival in the present study was significantly longer in patients receiving chemotherapy after the diagnosis of ureteral obstruction than that in patients without chemotherapy.…”

Pilot study of a combination of S-1 and paclitaxel for patients with peritoneal metastasis from gastric cancer

“…Laparoscopy was performed under general anesthesia as an independent procedure by the method we reported previously [17]. After close examination of the peritoneal cavity, peritoneal lavage cytology was performed in the Douglas pouch and left subphrenic space.…”

Weekly Intravenous and Intraperitoneal Paclitaxel Combined with S-1 for Malignant Ascites due to Advanced Gastric Cancer

“…The regimen including intraperitoneal PTX was shown to prolong survival in a recent phase III study [10] and was approved as the recommended regimen of the National Cancer Institute. On the other hand, no clinical trial has examined peritoneal metastases due to gastric cancer, which are biologically more malignant, although several cases with dramatic effects have been reported [11,12]. …”