Affiliations
- 1Department of Haematology-Oncology, National University Cancer Institute, Singapore.
- 2University Surgical Cluster, National University Health System, Singapore.
- 3Division of Surgical Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore.
- 4Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
- 5Singapore Gastric Cancer Consortium, Singapore.
- 6Department of GI Surgery, Ghent University Hospital, and Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium.
- 7Cancer Science Institute of Singapore, National University of Singapore, Singapore.
- 8Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore.
- 9Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore.
- 10SingHealth/Duke-NUS Institute of Precision Medicine, National Heart Centre Singapore, Singapore.
- 11Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
- 12Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), National Cancer Centre Singapore, Singapore.
- 13Division of Surgery and Surgical Oncology, Department of Sarcoma, Peritoneal and Rare Tumors (SPRinT), Singapore General Hospital, Singapore.
- 14Laboratory of Applied Human Genetics, Division of Medical Sciences, National Cancer Centre Singapore, Singapore.
- 15SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore.
- 16SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore.
- 17Institute of Molecular and Cell Biology, A*STAR Research Entities, Singapore.
- 18The N.1 Institute for Health, National University of Singapore, Singapore.
Abstract
The peritoneum is a common site of metastasis in advanced gastric cancer (GC). Diagnostic laparoscopy is now routinely performed as part of disease staging, leading to an earlier diagnosis of synchronous peritoneal metastasis (PM). The biology of GCPM is unique and aggressive, leading to a dismal prognosis. These tumors tend to be resistant to traditional systemic therapy, and yet, this remains the current standard-of-care recommended by most international clinical guidelines. As this is an area of unmet clinical need, several translational studies and clinical trials have focused on addressing this specific disease state. Advances in genomic sequencing and molecular profiling have revealed several promising therapeutic targets and elucidated novel biology, particularly on the role of the surrounding tumor microenvironment in GCPM. Peritoneal-specific clinical trials are being designed with a combination of locoregional therapeutic strategies with systemic therapy. In this review, we summarize the new knowledge of cancer biology, advances in surgical techniques, and emergence of novel therapies as an integrated strategy emerges to address GCPM as a distinct clinical entity.
PMID: 35649219 DOI: 10.1200/JCO.21.02745