Summary of STOPGAP trial: a Phase II clinical trial for gastric and gastroesophageal junction cancers

PFCCAP Admin
May 1
3 min read

Maheswari Senthil, Farshid Dayyani

BMC Cancer

This research article about the STOPGAP trial explores a new treatment approach for patients with advanced stomach or gastric cancers that have spread to the lining of the abdomen, a condition known as peritoneal carcinomatosis (PC).

Gastric cancer is a significant global health concern, ranking among the top causes of cancer-related deaths. A common complication in advanced stages is peritoneal carcinomatosis, where cancer cells spread to the peritoneal cavity, leading to a poor prognosis. Traditional systemic chemotherapy often struggles to effectively treat peritoneal carcinomatosis (PC) due to the limited penetration of drugs into the peritoneal cavity.

By integrating systemic and regional chemotherapy approaches, the trial seeks to enhance drug delivery to the peritoneal cavity, potentially improving survival outcomes and quality of life for patients with gastric or gastroesophageal junction (GEJ) cancers complicated by peritoneal carcinomatosis (PC).

The findings from the STOPGAP trial could pave the way for larger, multi-institutional studies and potentially establish a new standard of care for managing peritoneal carcinomatosis in gastric cancer patients.

A summary of the findings are provided below. Read the full article here.

Background

Gastric (stomach) and gastroesophageal junction (GEJ) cancers can be very difficult to treat when they spread to the lining of the abdomen—a condition called peritoneal carcinomatosis (PC). Standard chemotherapy alone often struggles to reach cancer cells in this area, resulting in poor outcomes of 6-15 months of survival. The STOPGAP trial explored a new approach: starting with regular (systemic) chemotherapy and then adding chemotherapy delivered directly into the abdominal cavity (intraperitoneal paclitaxel) to better target cancer cells in the peritoneum.

While the use of normothermic intraperitoneal chemotherapy (NIPEC) (a liquid chemotherapy wash applied directly within the abdominal cavity where the chemotherapy is kept at body temperature and typically administered in multiple rounds). NIPEC is a treatment option for malignant peritoneal mesothelioma, as well as other abdominal cancers is widespread and often utilized to treat gastric cancer in Asia, it has not been tested on western populations, which is important due to the inherent biological differences in gastric cancer in eastern and western populations.

Study Purpose

Who Participated

The trial included 27 patients with gastric or GEJ adenocarcinoma that had either:

Positive peritoneal cytology (cancer cells found in abdominal fluid), or
Visible peritoneal cancer.

All patients began treatment with three months of systemic chemotherapy. If the cancer hadn’t progressed, they were eligible to move on to a second phase of treatment combining systemic and intraperitoneal chemotherapy. Some patients who responded well and had limited disease spread were also considered for surgery and heated chemotherapy during surgery (HIPEC).

Key Findings

The results suggest that combining systemic and intraperitoneal chemotherapy is a promising strategy for treating gastric and GEJ cancers that have spread throughout the peritoneal cavity. The approach allowed for better targeting of cancer in the abdominal lining, was feasible for most patients, and showed encouraging survival outcomes. Importantly, some patients had their disease controlled enough to become eligible for HIPEC surgery—something rarely possible in this setting.

The researchers emphasize the need for larger, multi-center trials to confirm these findings and potentially change the standard approach for this challenging condition.