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

Abstract

dissemination still have a poor prognosis [1]; most of these patients die within 6 months of diagnosis, while the 5-year survival rate is nil [2,3].The recent introduction of an oral drug, S-1, has increased the overall response rates (ORRs) to 44% and 49% and median survival time (MST) to 8 months in phase II studies [4,5].Several reports have demonstrated that S-1 was effective for undifferentiated histological types, such as poorly differentiated adenocarcinoma and signet-ring cell carcinoma, which are relevant to peritoneal dissemination [6]. S-1 has been reported to be effective in prolonging the survival of gastric cancer patients with peritoneal dissemination [4][5][6][7].Moreover, S-1 in combination with other anticancer drugs such as cisplatin (CDDP), taxanes, and irinotecan (CPT-11) increased ORRs and prolonged MST [8][9][10][11].Paclitaxel is a cytotoxic antineoplastic agent that causes excessive polymerization of tubulin and microtubule dysfunction, resulting in tumor cell death [12]. Kobayashi et al. [13] have demonstrated that paclitaxel is a promising drug for the treatment of malignant ascites in patients with gastric cancer: the concentration of paclitaxel in ascites was maintained within the optimal level for the treatment of cancer cells for up to 72 h after intravenous administration.Recent phase II studies of systemic chemotherapy with S-1 plus taxanes have demonstrated strong anticancer effects and a good MST in the treatment of advanced gastric cancer [9,10,14]. However, the effi cacy of systemic chemotherapy for peritoneal dissemination from gastric cancer has been unclear, because peritoneal metastases have not been defi ned as measurable lesions in conventional phase II studies. Therefore, few reports describing the effi cacy of chemotherapy for these lesions are available.In this pilot study, we planned therapeutic strategies to observe the effect of chemotherapy on peritoneal metastasis by second-look laparoscopy for patients Abstract Background. This pilot study was carried out to evaluate the effi cacy of chemotherapy for patients with peritoneal dissemination from gastric cancer or positive lavage cytology diagnosed by staging laparoscopy. Methods. Sixteen patients were enrolled. Paclitaxel was administered at 120 mg/m 2 on day 1 and S-1 was administered orally at 80 mg/m 2 for 14 consecutive days, followed by a 1-week rest, as one course. After fi ve courses of this therapy, the primary gastric tumors were evaluated and second-look laparoscopy was performed for patients showing partial response or stable disease with clinical benefi t. Results. Partial response or stable disease with clinical benefi t was confi rmed in seven and fi ve patients, respectively, and these patients underwent second-look laparoscopy. No viable cancer cells were detected on cytopathological investigation during second-look laparoscopy in 9 patients who underwent surgical treatment. The intent-to-treat response rate for gastric tumor was 44% and the rate of disappearance of peritoneal metastasis was 38% ...

Randomized Phase III Study of 5-Fluorouracil Continuous Infusion vs. Sequential Methotrexate and 5-Fluorouracil Therapy in Far Advanced Gastric Cancer with Peritoneal Metastasis (JCOG0106)

“…Although some Phase III trials for metastatic gastric cancer have established standard chemotherapies, some anticancer drugs used in standard therapies, such as cisplatin or irinotecan, can scarcely be administered to gastric cancer patients with peritoneal metastasis, as it is likely to cause serious and sustained toxicity resulting from reduced metabolism and/or excretion (retention in ascites). For these reasons, large-scale trials for gastric cancer with peritoneal metastasis have not been conducted, and a standard chemotherapy regimen in this area has yet to be established (19)(20)(21)(22).…”

Uneven haustra on CT colonography: a clue for the detection of transperitoneal invasion from gastric cancer

“…However, early treatment for peritoneal metastases with newer chemotherapeutic agents may improve survival [18,19]. It would appear that a less-invasive, clinically feasible CTC-imaging technique would be useful for preoperative work-up and follow-up imaging in gastric cancer.…”

Metastases to the brain and to the skull base of carcinomas that are rarely metastasize to the central nervous system. Clinical and morphological analysis of 51 cases and literature review

“…Также редко встречаются метастазы рака эндометрия [12], желудка [18], ротовой полости [6], печени [1], поджелудочной же-лезы [2].…”