Beyond PERISCOPE II: Redesigning Peritoneal-Directed Treatment for Gastric Cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• Peritoneal metastases represent a significant challenge in gastric cancer management.
• Limited data exists on integrated operative strategies versus continued systemic therapy for selected patients.

Purpose of the Study:

• To compare an integrated operative strategy (gastrectomy, cytoreductive surgery, heated chemotherapy) with continued systemic therapy in gastric cancer patients with limited peritoneal disease.
• To evaluate the efficacy and safety of this integrated approach.

Main Methods:

• PERISCOPE II was a randomized trial comparing surgery plus chemotherapy against systemic therapy alone.
• Patients had limited peritoneal disease and underwent gastrectomy, cytoreductive surgery (CRS), and sequential heated oxaliplatin-normothermic docetaxel.
• The intervention was initiated after brief systemic treatment without mandatory laparoscopic response confirmation before randomization.

Main Results:

• The integrated operative strategy did not improve survival compared to continued systemic therapy.
• The intervention was associated with substantial morbidity.
• The trial design and timing of intervention may have impacted outcomes, as suggested by other studies like DRAGON-01 and STOPGAP.

Conclusions:

• Routine adoption of the PERISCOPE II integrated operative pathway is not recommended due to lack of survival benefit and significant morbidity.
• Future research should investigate intraperitoneal therapy as an addition to systemic treatment and explore operative consolidation for exceptional responders identified through response-directed surgery.