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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2015; 7(11): 285-291
Published online Nov 15, 2015. doi: 10.4251/wjgo.v7.i11.285
Breakthrough therapy for peritoneal carcinomatosis of gastric cancer: Intraperitoneal chemotherapy with taxanes
Hironori Yamaguchi, Joji Kitayama, Hironori Ishigami, Shinsuke Kazama, Hiroaki Nozawa, Kazushige Kawai, Keisuke Hata, Tomomichi Kiyomatsu, Toshiaki Tanaka, Junichiro Tanaka, Takeshi Nishikawa, Kensuke Otani, Koji Yasuda, Soichiro Ishihara, Eiji Sunami, Toshiaki Watanabe
Hironori Yamaguchi, Joji Kitayama, Hironori Ishigami, Shinsuke Kazama, Hiroaki Nozawa, Kazushige Kawai, Keisuke Hata, Tomomichi Kiyomatsu, Toshiaki Tanaka, Junichiro Tanaka, Takeshi Nishikawa, Kensuke Otani, Koji Yasuda, Soichiro Ishihara, Eiji Sunami, Toshiaki Watanabe, Department of Surgical Oncology, the University of Tokyo, Tokyo 113-8655, Japan
Author contributions: Yamaguchi H, Kazama S, Nozawa H, Kawai K, Hata K, Kiyomatsu T, Tanaka T, Tanaka J, Nishikawa T, Otani K and Yasuda K performed the literature research; Yamaguchi H, Ishihara S and Sunami E reviewed the paper; Kitayama J, Ishigami H and Watanabe T supervised the project; Yamaguchi H wrote the paper.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hironori Yamaguchi, MD, PhD, Department of Surgical Oncology, the University of Tokyo, 7-3-1 Hongo Bunkyoku, Tokyo 113-8655, Japan. yamaguchih-tky@umin.net
Telephone: +81-3-58008653 Fax: +81-3-38116822
Received: May 4, 2015
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
Processing time: 196 Days and 10.2 Hours
Abstract

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.

Keywords: Taxane; Paclitaxel; Docetaxel; Carcinoma; Gastric cancer; Intraperitoneal infusions; Cytoreduction surgical procedures

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.