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Mura et al. The peritoneal metastases from GC

Figure 3: Catumaxomab, is a chimeric antibody, consisting in a mouse-derived anti-EpCAM Fab (fragment antigen-binding) region and a
rat-derived anti CD3 Fab
with intraperitoneal chemotherapy or surgery without a D2 gastrectomy and then randomized to receive
intraperitoneal chemotherapy. In both analyses a highly HIPEC or no HIPEC. Prophylactic/adjuvant setting
[67]
significant improvement in survival and in peritoneal is the more evidence-based indication for HIPEC
recurrence rate was demonstrated for the HIPEC in advanced-stage GC patients. No peritonectomy
group compared to the control group. Recently, a meta- procedures are needed; post-operative morbidity and
analysis on effects of intraperitoneal chemotherapy in mortality are the same than surgery alone. Anyway
advanced GC was reported by Coccolini et al. They a better and “standardized” identification of subset
[64]
imported the data from 20 prospective studies involving of patients at high risk of peritoneal recurrence is
2,145 patients. Overall suvival was increased when necessary. [68]
intraperitoneal chemotherapy was added to surgery;
intraperitoneal chemotherapy was found to reduce Intraperitoneal immunotherapy
the incidence of peritoneal recurrence and distant Survival results for the treatment of PC from GC
metastases. In the German S3-guidelines “Diagnosis remain disappointing even with HIPEC, with 5-year
and treatment of esophagogastric cancer” HIPEC as survival rates of less than 25% in selected cases
adjuvant treatment is reported with Level of Evidence only. Innovative therapies such as intraperitoneal
I, grade A. [65] immunotherapy have been recently proposed.

Most of data anyway come from studies that have The Chimera it’s a legendary fire-breathing monster
been conducted in Far-Eastern countries, with scarce comprised of a lion, a goat, and a serpent. And chimera
contribute from the western world. Two RCTs about in genetics is a single animal organism with genetically
adjuvant HIPEC in GC patients are currently on-going in distinct cells from two different zygotes. Chimera, or
Europe. The “GASTRICHIP” is a phase III randomized fusion protein, is called in biochemistry a hybrid protein
multicentre study evaluating the role of HIPEC with made by the splicing of two genes. Catumaxomab is a
oxaliplatin in patients with GC who have either serosal chimeric antibody, consisting in a mouse-derived anti-
infiltration and/or lymph nodal involvement and/ EpCAM Fab (fragment antigen-binding) region and a
or positive peritoneal cytology treated by a curative rat-derived anti CD3 Fab [Figure 3]. It is characterized
gastrectomy. Another trial is being conducted by the by its ability to bind to three different types of cells:
[66]
European network of excellence for gastric cancer. In tumour cells expressing the epithelial cell adhesion
this trial, patients with high risk GC will receive 3 cycles molecule (EpCAM), T lymphocytes (CD3) and also
of neoadjuvant systemic chemotherapy followed by accessory cells (Fcγ receptor). In nearly 90% of GC
Journal of Cancer Metastasis and Treatment ¦ Volume 2 ¦ September 18, 2016 369