Prof. Brian BADGWELL MD Andersen Cancer Center USA Link to biosketch

Abstract

The peritoneum is clearly the best target for improving survival in metastatic gastric cancer and a challenging disease site for systemic chemotherapy. Content will include a review of the most important components of treatment for peritoneal metastases. Hyperthermic intraperitoneal perfusion with chemotherapy (HIPEC) as treatment for stage IV gastric cancer will be extensively reviewed. New developments in the introduction of minimally invasive HIPEC will be discussed. The challenges of performing HIPEC and gastrectomy will also be highlighted. Arguably the most impactful ongoing study may be the PERISCOPE II trial, from the Netherlands Cancer Institute, which will include patients with gastric cancer and peritoneal disease with a peritoneal carcinomatosis index <7. For pressurized intraperitoneal aerosol chemotherapy (PIPAC), there are two ongoing trials with concomitant systemic therapy. An exciting and ambitious study is a randomized Phase II study of standard of care systemic chemotherapy versus cisplatin and doxorubicin PIPAC with systemic chemotherapy. Surgical oncologists should not be dissuaded by an inability to activate a randomized Phase III controlled trial. Based on single-arm Phase II trials, we have seen HIPEC included in guidelines for peritoneal malignancy and institutional algorithms. All patients included on such trials should have profiling performed to identify novel targets and variables associated with response. Regional therapy trials offer an excellent opportunity to obtain tissue for correlative studies and can offer a window into treatment response that is often not easily obtained during trials of systemic therapy alone. Leveraging minimally invasive techniques, such as laparoscopic HIPEC or PIPAC, can add to the value proposition for trial support.