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Gene Regulation and Targeted Therapy in Gastric Cancer Peritoneal Metastasis: Radiological Findings from Dual Energy CT and PET/CT
Published on: January 22, 2018
Immunotherapy for Peritoneal Metastases from Gastric Cancer: Rationale, Current Practice and Ongoing Trials
Eva Ruiz Hispán1, Manuel Pedregal1, Ion Cristobal2
1Department of Oncology, Fundación Jiménez Díaz University Hospital, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain.
Abstract:
Peritoneal metastases from gastric cancer play a key role in the fatal prognosis of the disease. The lack of efficacy of actual therapeutic approaches together with the outcomes achieved with checkpoint inhibitors in gastric cancer compel us to address the current state-of-the-art immunotherapy treatment of peritoneal dissemination. The immunogenicity of the peritoneum has been described to be particularly active at omentum and peritoneal lymph nodes. Also, both innate and acquired immunity seems to be involved at different molecular levels. Recent works show PDL1 expression being less present at the peritoneal level; however, some clinical trials have begun to yield results. For example, the ATTRACTION-2 trial has demonstrated the activity of Nivolumab in heavily pretreated patients even though peritoneal metastases were diagnosed in a 30% of them. Despite positive results in the metastatic setting, peritoneal responses to systemic checkpoint inhibitors remains unclear, therefore, new strategies for intraperitoneal immunotherapy are being proposed for different ongoing clinical trials.
Insights
Immunotherapy for peritoneal metastases in gastric cancer is crucial due to poor prognosis. While systemic checkpoint inhibitors show promise, intraperitoneal immunotherapy strategies are being explored for better treatment of peritoneal dissemination.
Area of Science:
- Oncology
- Immunology
- Gastroenterology
Background:
- Peritoneal metastases significantly worsen gastric cancer prognosis.
- Current therapies for peritoneal gastric cancer have limited efficacy.
- Checkpoint inhibitors show promise but their role in peritoneal disease requires further investigation.
Purpose of the Study:
- To review the current state of immunotherapy for peritoneal dissemination in gastric cancer.
- To explore the immunobiology of the peritoneum in the context of gastric cancer.
- To discuss emerging intraperitoneal immunotherapy strategies.
Main Methods:
- Literature review of immunotherapy in gastric cancer with peritoneal metastases.
- Analysis of clinical trial data regarding checkpoint inhibitors.
- Examination of peritoneal immunobiology and PD-L1 expression.
Main Results:
- The peritoneum, particularly the omentum and lymph nodes, exhibits significant immunogenicity.
- While PD-L1 expression may be lower at the peritoneal level, systemic checkpoint inhibitors like Nivolumab have shown activity.
- The ATTRACTION-2 trial demonstrated Nivolumab's efficacy in patients with peritoneal metastases.
Conclusions:
- Systemic checkpoint inhibitors offer a potential treatment avenue for gastric cancer with peritoneal metastases.
- The precise response of peritoneal metastases to systemic immunotherapy remains unclear.
- Intraperitoneal immunotherapy represents a promising novel strategy currently under investigation in clinical trials.
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