Appearance
The contemporary management of peritoneal metastasis: A journey from the cold past of treatment futility to a warm present and a bright future.
Literature Information
| DOI | 10.3322/caac.21749 |
|---|---|
| PMID | 35969103 |
| Journal | CA: a cancer journal for clinicians |
| Impact Factor | 232.4 |
| JCR Quartile | Q1 |
| Publication Year | 2023 |
| Times Cited | 44 |
| Keywords | cytoreductive surgery, hyperthermic intraperitoneal chemotherapy (HIPEC), multimodal management, peritoneal metastasis |
| Literature Type | Journal Article, Review |
| ISSN | 0007-9235 |
| Pages | 49-71 |
| Issue | 73(1) |
| Authors | Jason M Foster, Chunmeng Zhang, Shahyan Rehman, Prateek Sharma, H Richard Alexander |
TL;DR
This review highlights the significant impact of peritoneal metastasis (PM) on patient outcomes across various primary tumors, emphasizing the historical challenges in achieving durable symptom control and survival. It discusses advancements in multimodal treatment strategies, including the integration of hyperthermic intraperitoneal chemotherapy with cytoreductive surgery and systemic therapies, alongside the potential of precision medicine to enhance patient management and therapy selection for PM.
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cytoreductive surgery · hyperthermic intraperitoneal chemotherapy (HIPEC) · multimodal management · peritoneal metastasis
Abstract
Peritoneal metastasis (PM) is often regarded as a less frequent pattern of spread; however, collectively across all spectra of primary tumors, the consequences of PM impact a large population of patients annually. Unlike other modes of metastasis, symptoms at presentation or during the treatment course are common, representing an additional challenge in the management of PM. Early efforts with chemotherapy and incomplete surgical interventions transiently improved symptoms, but durable symptom control and survival extension were rare, which established a perspective of treatment futility for PM through most of the 20th century. Notably, the continued development of better systemic therapy combinations, optimization of cytoreductive surgery (CRS), and rigorous investigation of combining regional therapy-specifically hyperthermic intraperitoneal chemotherapy-with CRS, have resulted in more effective multimodal treatment options for patients with PM. In this article, the authors provide a comprehensive review of the data establishing the contemporary approach for tumors with a high frequency of PM, including appendix, colorectal, mesothelioma, and gastric cancers. The authors also explore the emerging role of adding hyperthermic intraperitoneal chemotherapy to the well established paradigm of CRS and systemic therapy for advanced ovarian cancer, as well as the recent clinical trials identifying the efficacy of poly(adenosine diphosphate ribose) polymerase maintenance therapy. Finally, recent data are included that explore the role of precision medicine technology in PM management that, in the future, may help further improve patient selection, identify the best systemic therapy regimens, detect actionable mutations, and identify new targets for drug development.
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Primary Questions Addressed
- What specific advancements in systemic therapy have contributed to improved outcomes for patients with peritoneal metastasis?
- How does the combination of hyperthermic intraperitoneal chemotherapy and cytoreductive surgery enhance treatment efficacy in peritoneal metastasis?
- What are the emerging biomarkers or genetic mutations that are being targeted in the management of peritoneal metastasis?
- In what ways can precision medicine technologies improve patient selection and treatment strategies for those with peritoneal metastasis?
- What role do clinical trials play in shaping the future treatment landscape for peritoneal metastasis, particularly for high-frequency tumors?
Key Findings
1. Research Background and Objective: Peritoneal metastasis (PM) has historically been viewed as a challenging condition with limited treatment options, primarily due to its association with advanced stages of various primary tumors. This form of metastasis affects a significant number of patients each year, yet it has been underappreciated in terms of its clinical impact. The objective of this research is to analyze the evolution of management strategies for PM, moving from historical perceptions of treatment futility to contemporary approaches that demonstrate improved outcomes. The authors aim to review current multimodal treatment options and explore future directions in precision medicine for better PM management.
2. Main Methods and Findings: The article presents a comprehensive review of existing literature and clinical data regarding the management of PM, particularly for cancers with a high prevalence of PM such as appendiceal, colorectal, mesothelioma, and gastric cancers. The authors discuss the advancements in systemic therapies, the optimization of cytoreductive surgery (CRS), and the integration of hyperthermic intraperitoneal chemotherapy (HIPEC) with CRS. They highlight the efficacy of these combined approaches, which provide improved symptom control and survival rates compared to historical treatments. Additionally, the review addresses the promising role of poly(adenosine diphosphate ribose) polymerase (PARP) maintenance therapy in advanced ovarian cancer and the implications of precision medicine in identifying actionable mutations and optimizing treatment regimens.
3. Core Conclusions: The findings indicate a significant shift in the management of PM, with contemporary strategies yielding better patient outcomes than those of the past. The integration of multimodal therapies, including HIPEC alongside CRS, has transformed PM from a condition previously viewed as untreatable into one where patients can experience durable symptom relief and extended survival. The evolving landscape of precision medicine further enhances the potential for personalized treatment approaches, allowing for more effective targeting of therapies based on individual patient profiles.
4. Research Significance and Impact: This research underscores the importance of reevaluating treatment paradigms for PM, advocating for a multidisciplinary approach that combines surgical, regional, and systemic therapies. The insights provided may influence clinical practice by encouraging oncologists to adopt these contemporary strategies, ultimately leading to improved patient outcomes. Furthermore, by emphasizing the role of precision medicine, the study highlights the potential for future innovations in PM management, paving the way for more effective treatments tailored to the genetic and molecular characteristics of individual tumors. This research not only enhances the understanding of PM management but also contributes to the broader field of oncology by promoting advancements in patient-centered care.
Literatures Citing This Work
- The BRD4 inhibitor JQ1 augments the antitumor efficacy of abemaciclib in preclinical models of gastric carcinoma. - Mei Feng;Hao Xu;Wenyuan Zhou;Yisheng Pan - Journal of experimental & clinical cancer research : CR (2023)
- Single-cell transcriptomics in ovarian cancer identify a metastasis-associated cell cluster overexpressed RAB13. - Jiahao Guo;Xiaoyang Han;Jie Li;Zhefeng Li;Junjie Yi;Yan Gao;Xiaoting Zhao;Wentao Yue - Journal of translational medicine (2023)
- FMO family may serve as novel marker and potential therapeutic target for the peritoneal metastasis in gastric cancer. - Xumeng Gong;Dong Hou;Shengning Zhou;Jianan Tan;Guangyu Zhong;Bing Yang;Lang Xie;Fanghai Han;Lin Zhong - Frontiers in oncology (2023)
- Th1 cells inducing IFNγ response improves immunotherapy efficacy in gastric cancer. - Qi Cao;Ruidong Xue;Ning Zhang - Chinese journal of cancer research = Chung-kuo yen cheng yen chiu (2023)
- A phase I dose-finding trial of hyperthermic intraperitoneal docetaxel combined with cisplatin in patients with advanced-stage ovarian cancer. - Zhi-Yao You;Miao-Fang Wu;Hui Li;Yan-Fang Ye;Li-Juan Wang;Zhong-Qiu Lin;Jing Li - Journal of gynecologic oncology (2024)
- A novel risk model for predicting peritoneal metastasis in colorectal cancer based on the SEER database. - Li Yao;Huan Shao;Xinyi Zhang;Xuan Huang - Journal of cancer research and clinical oncology (2023)
- Remodeling the tumor immune microenvironment via siRNA therapy for precision cancer treatment. - Lingxi Jiang;Yao Qi;Lei Yang;Yangbao Miao;Weiming Ren;Hongmei Liu;Yi Huang;Shan Huang;Shiyin Chen;Yi Shi;Lulu Cai - Asian journal of pharmaceutical sciences (2023)
- ACLY promotes gastric tumorigenesis and accelerates peritoneal metastasis of gastric cancer regulated by HIF-1A. - Zhengyuan Yan;Kanghui Liu;Peng Xu;Zhengwei Chen;Pengpeng Zhang;Shengbin Pei;Quan Cheng;Shansong Huang;Bowen Li;Jialun Lv;Zekuan Xu;Hao Xu;Li Yang;Diancai Zhang - Cell cycle (Georgetown, Tex.) (2023)
- The prophylactic role of mitomycin C-based hyperthermic intraperitoneal chemotherapy (MMC-based HIPEC) on peritoneal metastasis of spontaneously ruptured hepatocellular carcinoma (srHCC): A pilot study. - Ziqi Hou;Guoteng Qiu;Qingyun Xie;Zhaoxing Jin;Shizheng Mi;Jiwei Huang - Global health & medicine (2023)
- Real-world Study on the Effect of PARPi as Maintenance Therapy on Platinum Sensitivity after First- and Second-line Chemotherapy in Patients with Recurrent High-grade Serous Epithelial Ovarian Cancer. - Yanglong Guo;Xi Chen;Xuedong Tang;Shan Pan;Tao Zhu;Yingli Zhang - Current cancer drug targets (2024)
... (34 more literatures)
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