Daryl K A Chia1, Raghav Sundar2,3,4, Guowei Kim1, Jia Jun Ang1, Jeffrey H Y Lum5, Min En Nga5, Giap Hean Goh5, Ju Ee Seet5, Cheng Ean Chee2, Hon Lyn Tan2, Jingshan Ho2, Natalie Y L Ngoi2, Matilda X W Lee2, Vaishnavi Muthu2, Gloria H J Chan2, Angela S L Pang2, Yvonne L E Ang2, Joan R E Choo2, Joline S J Lim2, Jun Liang Teh6, Aung Lwin6, Yuen Soon6, Asim Shabbir1,3,7, Jimmy B Y So8,9,10, Wei Peng Yong2,11. 1. Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore. 2. Department of Haematology-Oncology, National University Cancer Institute National University Health System, Singapore, Singapore. 3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 4. The N.1 Institute for Health, National University of Singapore, Singapore, Singapore. 5. Department of Pathology, National University Hospital, National University Health System, Singapore, Singapore. 6. Department of General Surgery, Ng Teng Fong General Hospital, Singapore, Singapore. 7. Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore. 8. Department of Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore. jimmyso@nus.edu.sg. 9. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. jimmyso@nus.edu.sg. 10. Division of Surgical Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore. jimmyso@nus.edu.sg. 11. Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore.
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.
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.
Authors: Deborah K Armstrong; Brian Bundy; Lari Wenzel; Helen Q Huang; Rebecca Baergen; Shashikant Lele; Larry J Copeland; Joan L Walker; Robert A Burger Journal: N Engl J Med Date: 2006-01-05 Impact factor: 91.245
Authors: K Muro; E Van Cutsem; Y Narita; G Pentheroudakis; E Baba; J Li; M-H Ryu; W I Wan Zamaniah; W-P Yong; K-H Yeh; K Kato; Z Lu; B C Cho; I M Nor; M Ng; L-T Chen; T E Nakajima; K Shitara; H Kawakami; T Tsushima; T Yoshino; F Lordick; E Martinelli; E C Smyth; D Arnold; H Minami; J Tabernero; J-Y Douillard Journal: Ann Oncol Date: 2019-01-01 Impact factor: 32.976
Authors: B Sadeghi; C Arvieux; O Glehen; A C Beaujard; M Rivoire; J Baulieux; E Fontaumard; A Brachet; J L Caillot; J L Faure; J Porcheron; J L Peix; Y François; J Vignal; F N Gilly Journal: Cancer Date: 2000-01-15 Impact factor: 6.860