PIPAC and FOLFOX for Gastric Cancer Peritoneal Cancer

Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) and Systemic Chemotherapy as a First-line Treatment for Gastric Cancer Peritoneal Metastases: Open-label, Single-arm, Multi-center Feasibility Study

Peritoneum is among the most common sites of metastases in gastric cancer. Systemic chemotherapy is the current standard for peritoneal carcinomatosis (PC), although, the treatment results remain extremely poor. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a modern treatment modality for PC, that 1) optimize the drug distribution by applying an aerosol rather than a liquid solution; and 2) apply increased intraperitoneal hydrostatic pressure to increase drug penetration to the target. Despite some encouraging preliminary results for PIPAC efficacy, it is still an investigational treatment. Furthermore, only very limited data exist for bidirectional treatment, which includes a combination of systemic chemotherapy and PIPAC. Thus, this study will investigate the feasibility of PIPAC and systemic chemotherapy combination for gastric cancer patients with peritoneal metastases.

Study Overview

• Status: Completed
• Conditions: Gastric Cancer; Peritoneal Carcinomatosis
• Intervention / Treatment: Drug: Combined Doxorubicin and Cisplatin Pressurized IntraPeritoneal Aerosol Chemotherapy With Systemic FOLFOX chemotherapy

Detailed Description

This open-label, single-arm feasibility study will be conducted at two major gastrointestinal cancer treatment centers in Lithuania and will include 37 participants. Gastric cancer patients diagnosed with a synchronous or metachronous peritoneal carcinomatosis based on a clinical, radiological, cytological, and histological examination will be considered for enrollment. Thirty-seven patients willing to participate and meeting the enrollment criteria will be scheduled for the experimental treatment. Three cycles of 1st line palliative systemic chemotherapy will be administered every 28 days and PIPAC with cisplatin 10,5 mg/m2 and doxorubicin 2,1 mg/m2 will be utilized 14 days after each of the systemic chemotherapy cycles. After the 3rd PIPAC procedure patients will be re-assessed and discussed at multidisciplinary team meetings. In case of downstaging patients will be considered for radical gastrectomy±cytoreductive surgery; others for further systemic therapy. All patients will be followed up for 24 months.

• Study Type: Interventional
• Enrollment (Actual): 37
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Lithuania
  • Vilniaus
    • Vilnius, Vilniaus, Lithuania, 08406
      • Nationa Cancer Institute
    • Vilnius, Vilniaus, Lithuania, 08661
      • Vilnius University Hospital Santaros Klinikos

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Histologically verified gastric adenocarcinoma (HER2 negative) with peritoneal carcinomatosis;
2. Age≥18;
3. ECOG≤1;
4. Patient willing to participate;
5. Patient is the candidate for 1st line FOLFOX palliative systemic chemotherapy.

Exclusion Criteria:

1. Extra-abdominal metastases;
2. Siewert I type gastroesophageal junction cancer;
3. Mechanical bowel obstruction;
4. Allergy to study drugs;
5. History of previous intraperitoneal chemotherapy;
6. Pregnancy of refusal for birth-control at least 6 months post-study treatment

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: Experimental treatment; Each patient will be scheduled for 3 courses of combined treatment: in total 3 PIPAC with cisplatin 10.5 mg/m2 and doxorubicin 2.1 mg/m2 and 6 cycles of FOLFOX systemic chemotherapy.

Drug: Combined Doxorubicin and Cisplatin Pressurized IntraPeritoneal Aerosol Chemotherapy With Systemic FOLFOX chemotherapy; Each course of combined treatment will start with PIPAC (a pressurized aerosol containing cisplatin 10.5 mg/m2 and doxorubicin 2.1 mg/m2 diluted in NaCl 0.9% applied through the nebulizer inside the abdominal cavity during laparoscopy). Fourteen days afterward 2 cycles of systemic FOLFOX chemotherapy will be applied within 28 days. The interval between combined treatment courses will be 14 days.; Other Names: PIPAC

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective tumor response according to RECIST v 1.1 after second PIPAC	Objective tumor response according to RECIST v 1.1 in CT scan performed 1 week after second PIPAC procedure	Day 7 after second PIPAC procedure (an average of 8 weeks after start of the study)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Objective tumor response according to RECIST v 1.1	Objective tumor response according to RECIST v 1.1 in CT scan performed 1 week after third PIPAC procedure	Day 7 after third PIPAC procedure (an average of 15 weeks after start of the study)
Compliance to treatment	Proportion of patients able to receive all anticipated treatment (3 PIPACs and 6 cycles of FOLFOX)	Through study completion, an average of 28 months
Postoperative complication assessed by Clavien-Dindo score	The number of patients with postoperative complications, defined and graded according to Clavien-Dindo classification	Through study completion, an average of 28 months
Peritoneal carcinomatosis index and histological regression according to peritoneal regression grading score (PRGS).	A pathologist blinded to clinical outcomes will evaluate histological tumor response using the Peritoneal Regression Grading Score (PRGS): 1-Complete regression without cancer cells; 2-higher response with prevalence of regressive phenomena and only a few residual cancer cells - PRGS; 3-minor response with prevalence of residual cancer cells and poor regressive phenomena; 4-no response to therapy without regressive phenomena. A patient will be considered a responder if any reduction in the PRGS during subsequent biopsies will be recorded.	Through study completion, an average of 28 months
Ascites volume	The volume of ascites recorded at every PIPAC procedure.	Through study completion, an average of 28 months
Tumor markers	Ca19-9, carcinoembryonic antigen (CEA), Ca72-4 plasma levels measured at different time points.	Through study completion, an average of 28 months
Quality of life by EORTC questionnaires	Quality of life by EORTC questionnaires measured at different time points.	Through study completion, an average of 28 months
Overall survival	Time from start of the treatment to death	From treatment start to death, assessed up to 24 months
Progression-free survival	Time from start of the treatment to progression of the disease	From treatment start to death, assessed up to 24 months
Adverse events of chemotherapy drugs	The number of patients with toxicity according to Common Terminology Criteria for Adverse Events (CTCAE) V5.0 during the study period	Through study completion, an average of 28 months

Collaborators and Investigators

• Sponsor: Vilnius University
• Collaborators: National Cancer Institute (NCI); Vilnius University Hospital Santaros Klinikos
• Investigators: Principal Investigator: Skaiste Tulyte, MD, Vilnius University Hospital Santaros Klinikos

Publications and helpful links

General Publications

• Luksta M, Bausys A, Bickaite K, Rackauskas R, Paskonis M, Luksaite-Lukste R, Ranceva A, Stulpinas R, Brasiuniene B, Baltruskeviciene E, Lachej N, Sabaliauskaite R, Bausys R, Tulyte S, Strupas K. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) with cisplatin and doxorubicin in combination with FOLFOX chemotherapy as a first-line treatment for gastric cancer patients with peritoneal metastases: single-arm phase II study. BMC Cancer. 2023 Oct 25;23(1):1032. doi: 10.1186/s12885-023-11549-z.

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2022
• Primary Completion (Actual): June 1, 2025
• Study Completion (Actual): September 1, 2025

Study Registration Dates

• First Submitted: September 29, 2022
• First Submitted That Met QC Criteria: November 30, 2022
• First Posted (Actual): December 9, 2022

Study Record Updates

• Last Update Posted (Estimated): September 24, 2025
• Last Update Submitted That Met QC Criteria: September 19, 2025
• Last Verified: September 1, 2025

More Information

Terms related to this study

• Keywords: Gastric cancer; FOLFOX; Peritoneal carcinomatosis; PIPAC; Bidirectional
• Additional Relevant MeSH Terms: Neoplasms by Site; Neoplasms; Gastrointestinal Neoplasms; Digestive System Neoplasms; Digestive System Diseases; Gastrointestinal Diseases; Stomach Diseases; Peritoneal Diseases; Abdominal Neoplasms; Stomach Neoplasms; Peritoneal Neoplasms; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Antineoplastic Agents; Topoisomerase II Inhibitors; Topoisomerase Inhibitors; Antibiotics, Antineoplastic; Doxorubicin
• Other Study ID Numbers: V1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No