Dr. Janjigian on Extensive Intraoperative Peritoneal Lavage in Gastric Cancer

Yelena Y. Janjigian, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center, discusses data examining surgery plus extensive intraoperative peritoneal lavage (EIPL) versus surgery alone in patients with gastric cancer.

Unfortunately, were mostly negative studies were presented at the 2020 Gastrointestinal Cancers Symposium, says Janjigian. For example, a negative phase 3 study from Asia in surgical cases with gastric cancer was presented. No clear benefit was observed with peritoneal lavage or peritoneal-directed washings in patients with gastric cancer and cytology-positive disease. The question that repeatedly arises is, “Should more localized therapy be conducted to try and cure these patients?”

Patients enrolled were diagnosed with cT3/4 stomach cancer and undergoing curative resection. They were randomized to either surgery and EIPL or surgery alone. After a median follow-up of 29 months, the 3-year cumulative incidence of all-cause mortality was 23.1% and 23.3% for EIPL and surgery alone, respectively (HR, 1.09; 95% CI, 0.78-1.52, P =.615). The 3-year cumulative incidence of recurrence were 28.0% and 25.9%, respectively (HR, 1.01; 95% CI, 0.74-1.37, P =.947), and 7.9% and 6.6%, respectively, for peritoneal recurrence (HR, 1.33; 95% CI, 0.73-2.42; P =.347).

Data from this presentation suggest that these patients have advanced disease and unless patients are selected for specific biology in tumor subsets, the treatment is palliative in intent and no role for these peritoneal therapies exists, concludes Janjigian.