Help for advanced stomach cancer

Innovative clinical trial seeks better patient outcomes

Stomach cancer is the fourth leading cause of cancer deaths worldwide because it usually isn’t detected until it is in advanced stages. Among the most concerning is stomach cancer that has spread into the abdominal cavity and lining, or peritoneum.

Once cancer cells have invaded the peritoneum, the survival rate is only four to six months. Moreover, the incidence of gastric cancer is on the rise among adults under 50, especially Hispanics.

Surgical oncologist Dr. Maheswari Senthil, a specialist in advanced abdominal cancers and director of the UCI Health Chao Family Comprehensive Cancer Center’s Peritoneal Malignancy Program, is determined to change those statistics with a novel clinical trial.

“We are seeing an alarming increase in metastatic cancers, particularly gastric carcinomatosis in younger adults,” she says. “They need a fighting chance against this aggressive cancer.”

Boosting chemotherapy’s effectiveness

The current standard of care is intravenous (IV) chemotherapy, but studies show this regimen slows the cancer’s spread for about six months, then tumors usually start to grow again.

Evidence suggests that this treatment alone is insufficient because the peritoneal membrane reduces the drugs’ ability to penetrate the abdominal cavity.

Infusing higher doses of chemotherapy directly into the abdominal area after IV treatment may be more effective, says Senthil, who also serves as medical director of the UCI School of Medicine’s Center for Clinical Research.

To improve patients‘ options, she has teamed up with UCI Health medical oncologist Dr. Farshid Dayyani, a leading expert in gastrointestinal cancers and medical director of the cancer center’s Stern Center for Cancer Clinical Trials and Research.

Together, they have launched STOPGAP, a phase 2 clinical trial that takes a three-pronged approach to treating gastric carcinomatosis.

Participants start with three months of standard IV chemotherapy. Next, over a period of at least three months, a chemotherapy agent is infused directly into the peritoneum by way of a port implanted into the abdominal tissue.

Selected patients then undergo cytoreduction surgery to remove all visible signs of cancer from the abdominal cavity. The area is immediately bathed with a heated chemotherapy solution for about 90 minutes to kill any remaining microscopic cancer cells, a procedure called hyperthermic intraperitoneal chemotherapy (HIPEC).

After surgery, most patients receive monthly immunotherapy infusions to further reduce the risk of cancer recurrence.

Seeking better outcomes

STOPGAP is the only U.S. trial to use all three treatment modes for advanced gastric cancer. The goal is to demonstrate that this combination therapy is safe and improves patient survival rates. So far, seven patients are enrolled in the trial, which is actively recruiting up to 35 patients.

“Stage IV cancers can have very good outcomes with this type of care if you have the right team,” says Senthil, noting that UCI Health, home to the only National Cancer Institute-designated comprehensive center in Orange County, is one of the few in Southern California with the necessary level of expertise in all three treatment modes.

The study, one of more than 300 active cancer clinical trials at UCI Health, is funded in part by seed money from the UCI Anti-Cancer Challenge, the cancer center’s annual ride, run, walk fundraising event, which returns to in-person activities on Oct. 8 at the Irvine campus.

“The current standard of care for advanced gastric cancer is mainly palliative,” Senthil says. “We believe this approach will give these patients much better outcomes and longevity.”