A study suggests that continuous gastric artery infusion chemotherapy was effective and safe in relieving digestive obstruction in advanced gastric cancer.

Worldwide, gastric cancer (GC) is the fifth most common cancer and the third highest cause of cancer-related mortality. Due to its insidious onset, many patients with GC are initially diagnosed at an advanced stage, making them noncandidates for radical surgery. Importantly, obstruction or fullness after feeding is common in patients with GC and can affect nutritional status as well as quality of life. Relieving symptoms and resuming oral feeding as much as possible are key goals when managing patients with advanced GC accompanied by digestive obstruction.

Studies Lacking on Artery Infusion Chemotherapy in GC

Guidelines recommend considering intravenous (IV) chemotherapy first in patients with advanced GC, whereas palliative gastrectomy, gastrojejunostomy, endoluminal stents, and other treatments can be used to relieve digestive obstruction. However, surgery is not suitable for patients in poor health and systemic IV chemotherapy is often not well tolerated. Recently, intra-arterial chemotherapy has increasingly been used as an alternative to IV chemotherapy due to its mild adverse effects and significant efficacy. It has also achieved encouraging results in advanced GC, but reports on its effects on relieving digestive obstruction are lacking.

For a study published in the World Journal of Gastrointestinal Oncology, Ming Chao, MD, and colleagues analyzed patients with advanced GC-induced cardia or pyloric obstruction treated by constant gastric artery infusion chemotherapy (cGAIC). “The goal was to assess the safety and efficacy of this method for relieving digestive obstruction,” says Dr. Chao. The analysis included 29 patients with digestive obstruction of advanced GC who underwent at least one cycle of treatment. An oxaliplatin-based intra-arterial infusion regimen was applied in all patients, and mild systemic chemotherapy was used in combination with local treatment.

Improved ORR & mOS Seen With cGAIC in Advanced GC

According to the results, all patients with advanced GC finished cGAIC successfully without microcatheter displacement at a median follow-up of 24 months. After cGAIC, the overall response rate (ORR) was 89.7% overall, and postoperative dysphagia significantly improved. After the first treatment, patients immediately achieved an ORR of 86.2%, which is better than what has been seen in previous research. In addition, no patient exhibited disease progression at their following treatment.

For recipients of cGAIC, the median overall survival (mOS) was 16 months (95% CI, 9.32-22.68), according to the study (Figure, A). “Since cGAIC efficiently shrinks local lesions in the cardia or pylorus, obstruction symptoms can be quickly relieved in the first two treatment cycles for most patients, resulting in better nutritional status,” Dr. Chao says. Most patients (75.9%) experienced digestive obstruction relief after the first two cycles, and 44.8% of those who were initially unresectable were considered radically resectable after cGAIC. Participants with no chemotherapy history were more likely to benefit from cGAIC.

In a subgroup analysis, patients with relieved obstruction had a slightly longer mOS than those who did not experience relief (Figure, B). Those who underwent radical surgery had a significantly longer mOS than other patients. Several independent predictors of mOS were identified, including:

• Radical resection after cGAIC
• IV chemotherapy after cGAIC
• Immunotherapy after cGAIC

Of note, none of the patients in the study stopped treatment because of adverse events.

Striving for Higher Surgical Conversion Possibilities & Better Prognoses

Based on the effectiveness of local treatment, a single oral or IV chemotherapy drug was used in combination for the study. “This combination obtained better regional benefits and systemic control in distant metastasis and reduced the dosage of chemotherapy drugs and adverse events,” according to the authors. As such, patients with locally advanced GC can potentially achieve higher surgical conversion rates and better prognoses after cGAIC.

Although intra-arterial chemotherapy has been suggested to be safe and effective, controversy remains about chemotherapeutic drug selection and the speed of administration. The current study provides preliminary data demonstrating the efficacy and safety of cGAIC in relieving digestive obstruction in advanced GC. This improves prospects for future radical resection after cGAIC as well as survival time. The authors noted that intraoperative coronary and aorta computed tomography angiography may be used to help precisely define the perfusion area.