Published online Nov 15, 2015. doi: 10.4251/wjgo.v7.i11.285
Peer-review started: May 9, 2015
First decision: July 17, 2015
Revised: July 28, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: November 15, 2015
The effect of chemotherapy on peritoneal carcinomatosis (PC) of gastric cancer remains unclear. Recently, the intraperitoneal (IP) administration of taxanes [e.g., paclitaxel (PTX) and docetaxel (DOC)] during the perioperative period has shown promising results. Herein, we summarized the rationale and methodology for using IP chemotherapy with taxanes and reviewed the clinical results. IP administered taxanes remain in the IP space at an extremely high concentration for 48-72 h. The drug directly infiltrates peritoneal metastatic nodules from the surface and then produces antitumor effects, making it ideal for IP chemotherapy. There are two types of perioperative IP chemotherapy with taxanes: neoadjuvant intraperitoneal and systemic chemotherapy and sequential perioperative intraperitoneal chemotherapy (SPIC). In SPIC, patients receive neoadjuvant IP chemotherapy and the same regimen of IP chemotherapy after cytoreductive surgery (CRS) until disease progression. Usually, a taxane dissolved in 500-1000 mL of saline at ordinary temperature is administered through an IP access port on an outpatient basis. According to phase I studies, the recommended doses (RD) are as follows: IP DOC, 45-60 mg/m2; IP PTX [without intravenous (IV) PTX], 80 mg/m2; and IP PTX (with IV PTX), 20 mg/m2. Phase II studies have reported a median survival time of 14.4-24.6 mo with a 1-year overall survival of 67%-78%. A phase III study comparing S-1 in combination with IP and IV PTX to S-1 with IV cisplatin started in 2011. The prognosis of patients who underwent CRS was better than that of those who did not; however, this was partly due to selection bias. Although several phase II studies have shown promising results, a randomized controlled study is needed to validate the effectiveness of IP chemotherapy with taxanes for PC of gastric cancer.
Core tip: Herein, we provided an overview on the recent advances in intraperitoneal (IP) chemotherapy using taxanes (e.g., paclitaxel and docetaxel) for peritoneal carcinomatosis of gastric cancer. In particular, we focus on the rationale of IP chemotherapy with taxanes, treatment methodology, and results of current clinical studies. Intraperitoneally administered taxanes remain in the IP cavity for a long time, and they directly infiltrate the peritoneal metastatic nodule from the surface. Therefore, the repeated intra-abdominal administration of taxanes through an IP access port is needed to increase the antitumor effect of IP chemotherapy.