HIPEC in gastric cancer with peritoneal metastases

Hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastases from gastric cancer did not improve overall survival (OS). However, the procedure is safe and improves progression-free survival (PFS), results from GASTRIPEC I showed.

About 30% of patients with gastric cancer present with synchronous peritoneal metastases [1]. Cytoreductive surgery combined with perioperative systemic chemotherapy can improve survival in selected patients [2]. The randomised GASTRIPEC I trial (NCT02158988) aimed to evaluate the efficacy and safety of additional HIPEC to cytoreductive surgery and perioperative systemic chemotherapy in patients with peritoneal metastases from gastric cancer.

Patients were enrolled and randomised 1:1 to perioperative chemotherapy (epirubicin/oxaliplatin/capecitabine or cisplatin/capecitabine/trastuzumab depending on HER2 status) and cytoreductive surgery or perioperative chemotherapy, cytoreductive surgery, and HIPEC. Recruitment was stopped due to slow recruitment. Primary endpoint was OS, secondary endpoints were (amongst others) 30-day morbidity, PFS, toxicity, and hospital stay. Prof. Beate Rau (Charité University Hospital Berlin, Germany) presented the results of GASTRIPEC I [3].

In total, 55 patients stopped treatment before cytoreductive surgery because of disease progression or death. The primary endpoint was not met: median OS for both groups was 14.9 months. However, in patients with complete cytoreduction (CCR=0) HIPEC significantly improved OS: at 30 months, 30% of patients treated with HIPEC were still alive versus 0% of patients not treated with HIPEC (see Figure). Median PFS was significantly improved from 3.5 months in the non-HIPEC arm to 7.1 months in the HIPEC arm (P=0.0472). HIPEC had no impact on morbidity, complications, and/or hospital stay.

Figure: PFS, secondary endpoint of GASTRIPEC I [3]



Based on these results, Prof. Rau concluded that “addition of HIPEC to perioperative systemic chemotherapy and cytoreductive surgery does significantly improve PFS and OS after complete cytoreductive surgery. Additional HIPEC did not compromise patient’s safety.” HIPEC can be used in selective patients able to undergo a complete cytoreduction.

1. Tan HL, et al. Asia Pac J Clin Oncol. 2019;15:10-17.
2. Yarema R, et al. World J Gastrointest Oncol. 2020;12:569-58.
3. Rau B, et al. The effect of hyperthermic intraperitoneal chemotherapy (HIPEC) upon cytoreductive surgery (CRS) in gastric cancer (GC) with synchronous peritoneal metastasis (PM): A randomized multicentre phase III trial (GASTRIPEC-I-trial). Abstract 1376O, ESMO Congress 2021, 16–21 September.

 

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Posted on 19 November 202121 May 2024