Erschienen in:
07.09.2022 | Peritoneal Surface Malignancy
Outcomes of a Phase II Study of Intraperitoneal Paclitaxel plus Systemic Capecitabine and Oxaliplatin (XELOX) for Gastric Cancer with Peritoneal Metastases
verfasst von:
Daryl K. A. Chia, FRCS, Raghav Sundar, MRCP, Guowei Kim, FRCS, Jia Jun Ang, MRCS, Jeffrey H. Y. Lum, FRCPath, Min En Nga, FRCPath, Giap Hean Goh, FRCPath, Ju Ee Seet, FRCPath, Cheng Ean Chee, MRCP, Hon Lyn Tan, MRCP, Jingshan Ho, MRCP, Natalie Y. L. Ngoi, MRCP, Matilda X. W. Lee, MRCP, Vaishnavi Muthu, MRCP, Gloria H. J. Chan, MRCP, Angela S. L. Pang, MRCP, Yvonne L. E. Ang, MRCP, Joan R. E. Choo, MRCP, Joline S. J. Lim, MRCP, Jun Liang Teh, FRCS, Aung Lwin, FRCS, Yuen Soon, FRCS, Asim Shabbir, FRCS, Jimmy B. Y. So, FRCS, Wei Peng Yong, MRCP
Erschienen in:
Annals of Surgical Oncology
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Ausgabe 13/2022
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Abstract
Background
Adding intraperitoneal paclitaxel (IP-PTX) to paclitaxel/5-fluoropyrimidine has shown promising results in patients with gastric cancer peritoneal metastases (GCPM) but has not been studied with standard-of-care platinum/fluoropyrimidine combinations. Our goal to was evaluate IP-PTX with capecitabine/oxaliplatin (XELOX) in GCPM.
Methods
Forty-four patients with GCPM received IP PTX (40 mg/m2, Days 1, 8), oral capecitabine (1000 mg/m2 twice daily, Days 1–14) and intravenous oxaliplatin (100 mg/m2, Day 1) in 21-day cycles. Patients with synchronous GCPM underwent conversion surgery if they had good response after chemotherapy, conversion to negative cytology, no extraperitoneal metastasis, and no peritoneal disease during surgery. The primary endpoint was overall survival and secondary endpoints were progression-free survival and safety. Outcomes from the trial were compared against a matched cohort of 39 GCPM patients who received systemic chemotherapy (SC) comprising platinum/fluoropyrimidine.
Results
The median OS for the IP and SC groups was 14.6 and 10.6 months (hazard ratio [HR] 0.44; 95% confidence interval [CI], 0.26–0.74; p = 0.002). The median PFS for the IP and SC group was 9.5 and 4.4 months respectively (HR 0.39; 95% CI 0.25–0.66; p < 0.001). Patients in the SC group were younger (IP vs. SC, 61 vs. 56 years, p = 0.021) and had better performance status (ECOG 0, IP vs. SC, 47.7% vs. 76.9%, p = 0.007) compared with the IP cohort. In IP group, conversion surgery was performed in 36.1% (13/36) of patients, with a median OS of 24.2 (95% CI 13.1–35.3) months and 1-year OS of 84.6%.
Conclusions
IP PTX with XELOX is a promising treatment option for GCPM patients. In patients with good response, conversion surgery was feasible with favourable outcomes.