- Is multimodal therapy or standard systemic chemotherapy better at treating metastatic gastric cancer? One group of patients in this trial received multimodal therapy. This consisted of surgery with both hyperthermic intraperitoneal chemotherapy and systemic chemotherapy. The other group of patients received only systemic chemotherapy. The study found that multimodal therapy significantly increased survival in this small experiment.
- Rudloff, Udo, et al. “Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: results of the GYMSSA trial.” Journal of surgical oncology 110.3 (2014): 275-284. Available from: doi: doi.org/10.1002/jso.23633
- Published 2014
Impact Factor (IF):
Many advanced gastric cancer patients are treated with only chemotherapy. In the last few years, new research has started to show that multimodal therapy may be even more helpful than the standard systemic chemotherapy. This study wanted to know if this was true. Also, they wanted to know who would be helped most by multimodal therapy.
This experiment had 16 participants. These were all gastric cancer patients whose disease had not spread past the peritoneum, lungs or liver. Everybody was randomly assigned to a treatment group:
- SA group: these patients were given systemic chemotherapy only. The medicines they took were: oxaliplatin, irinotecan and fluorouracil. This is called the FOLFOXIRI chemotherapy routine. They took their medications once every two weeks for 6 months in total.
- There were 7 patients in this group.
- GYMS group: these patients were treated with surgery and two types of chemotherapy. First, all patients had surgery. The surgery included both a gastrectomy and a metastasectomy. This means that the stomach was removed, because it was the primary site of the cancer. The metastasectomy is used to cut tumor cells out from secondary sites. This method is called CRS (complete cytoreductive surgery). It tries to take out all visible signs of cancer. Next, they were given HIPEC (hyperthermic intraperitoneal chemotherapy) at the time of surgery. This means that chemotherapy is delivered within the peritoneum, right at the site of the surgery. The medicines oxaliplatin, fluorouracil and leucovorin were used right at the peritoneum in this study. Lastly, the GYMS group patients were also given the same FOLFOXIRI chemotherapy after surgery.
- There were 9 patients in this group.
- Chemotherapy drugs:
- Oxaliplatin: stops the genetic material in cancer cells from copying properly. This was given intravenously.
- Fluorouracil (5-FU): this drug also stops cancer cells from dividing properly. It may have the name ADRUCIL in Canada.
- Leucovorin: increases the anti-cancer effects of 5-FU.
- Irinotecan: stops the genetic material in the cells from being copied and doing its job properly. It is given intravenously.
Results: The researchers found that overall, the patients in the GYMS group lived longer. The median overall survival in the GYMS group was 11.3 months. It was only 4.3 months in the SA group. Also, they noticed that none of the SA patients lived more than 12 months after the start of the trial. 4 of the patients in the GYMS group lived for more than 12 months.
Even though this was a small experiment, it is important. Some patients in the GYMS group lived for years after treatment, but nobody in the SA group did. This shows that adding the surgery and HIPEC treatment may be more helpful than just chemotherapy. Also, this study was done in the USA. A lot of the data we have about gastric cancer was collected in East Asian countries where the disease is more common. In North America, gastric cancer is rarer. Like some of the larger studies from East Asia, this research showed that multimodal therapy was a better treatment plan than just systemic chemotherapy. So, the authors think that multimodal therapy can be a good choice for some North American gastric cancer patients.