title: Breakthrough therapy for peritoneal carcinomatosis of gastric cancer: Intraperitoneal chemotherapy with taxanes.
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/m(2); IP PTX [without intravenous (IV) PTX], 80 mg/m(2); and IP PTX (with IV PTX), 20 mg/m(2). 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.
authors.affiliation: 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.
authors.forename: Hironori
authors.initials: H
authors.lastname: Yamaguchi
authors.affiliation: 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.
authors.forename: Joji
authors.initials: J
authors.lastname: Kitayama
authors.affiliation: 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.
authors.forename: Hironori
authors.initials: H
authors.lastname: Ishigami
authors.affiliation: 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.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Kazama
authors.affiliation: 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.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nozawa
authors.affiliation: 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.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kawai
authors.affiliation: 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.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hata
authors.affiliation: 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.
authors.forename: Tomomichi
authors.initials: T
authors.lastname: Kiyomatsu
authors.affiliation: 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.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: 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.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Tanaka
authors.affiliation: 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.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishikawa
authors.affiliation: 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.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Otani
authors.affiliation: 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.
authors.forename: Koji
authors.initials: K
authors.lastname: Yasuda
authors.affiliation: 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.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ishihara
authors.affiliation: 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.
authors.forename: Eiji
authors.initials: E
authors.lastname: Sunami
authors.affiliation: 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.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
keywords: Carcinoma; Cytoreduction surgical procedures; Docetaxel; Gastric cancer; Intraperitoneal infusions; Paclitaxel; Taxane