Challenges, Prognosis, and Future Directions for Peritoneal Gastric Cancer

In the concluding segment of their conversation, the expert panel highlights the challenges and treatment considerations for patients with peritoneal gastric cancer. Moderated by Yelena Janjigian, MD, the panel explores the limited prognosis associated with peritoneal disease, the potential role of HIPEC and intraperitoneal chemotherapy, and the importance of enrolling patients in clinical trials. Finally, the panelists share their perspectives on current practices and future directions for improving outcomes in this complex patient population.

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Dr. Janjigian: In the last few minutes, I want to talk about disease with peritoneal disease, just briefly. There were some provocative small studies with intracranial taxing and so forth, HIPEC. Everything is all over the place. Maybe we’ll just start. What do you guys do for peritoneal disease at MD Anderson?

Dr. Blum Murphy: Yeah, so definitely peritoneal disease is a challenge. It’s well reported that patients with peritoneal disease to have work prognosis and oral survival in general. What we try to do in patients that have received chemotherapy and there is response, we try to enroll them in clinical trials with HIPEC or intracranial.

Dr. Janjigian: I think that’s key. I think we need to do more trials as opposed to a one-off. Although it’s very challenging. What are your-

Dr. Chakrabarti: Right, So peritoneal disease has a bad biology and they have poor prognosis. So this kind of disease is the perfect setting where we can do all the biomarker testing. We are getting more biomarkers of GFR, [inaudible 00:31:53]. I think we should check them all and try to hit those tumors with everything we have in the clinical trial setting.

Dr. Janjigian: Do you do HIPEC or intracranial chemotherapy at your center?

Dr. Chakrabarti: We do not. If there is a peritoneal disease, do not because not outside of a clinical trial, there is no data. So we do not do it.

Dr. Janjigian: And what about your center?

Dr. Sonbol: So I think with peritoneal disease, we’ve learned from FLOT5 Renaissance study that these patients, we definitely should not operate on them after a FLOT to go and operate site reduct surgery and all that. So that’s why I think it is important to enroll these patients on whether HIPEC or PIPAC or any of these studies. We do HIPEC in our center off-study for colon cancer. We used to have a study for gastric, but we don’t have it open. So now we just send them on. Because our HIPEC surgeon refuses to do it off-study, which I agree with. So we send them actually to the centers around.

Dr. Janjigian: There is an intracranial chemo study going through CTOP right now, so I think it would be great to do it. Sam, any final thoughts? You’re the future of this disease. How are you going to cure it?

Dr. Cytryn: I think it’s a really, really exciting time to be an investigator in this. And if you think about it, it’s the very beginning of 2025. And it was in the beginning of 2021, it was doublet chemotherapy and a fifth of patients trastuzumab and that was it. And now here we are having these dynamic conversations talking about increasing cure rates in perioperative setting. It’s a really interesting and exciting time and hopefully just continues to grow exponentially.

Dr. Janjigian: I agree. Well, thank you so much for joining and hope you enjoyed it. Have a good night.