Neoadjuvant Chemotherapy With SEEOX Regimen for Borrmann Type 4 Gastric Cancer

A Phase II Study of Neoadjuvant Chemotherapy With SEEOX Regimen Via Intra-arterial and Intravenous Administration Followed by Surgery for Borrmann Type 4 Gastric Cancer

Scirrhous gastric cancer, also known as linitis plastic or Borrmann type 4, is an aggressive tumor with an extremely poor prognosis. Aggressive surgical procedures and adjuvant chemotherapies have not improved the survival rate. The purpose of this study is to determine whether neoadjuvant Chemotherapy with SEEOX regimen via intra-arterial and intravenous administration are effective in the treatment of Borrmann type 4 gastric cancer.

Gastric cancer patients who diagnosed as Borrmann type 4 would be included in this study.They would receive 3 cycles of neoadjuvant chemotherapy with SEEOX regimen via combined intra-arterial and intravenous administration. The treatment schedule consisted of 3 courses (each, 2-week administration and 1-week withdrawal) of intra-arterial administration of oxaliplatin (150mg), etoposide (100mg) and epirubicin(30mg) by Seldinger method on day 1 and oral S-1(120mg) on days 1-14, followed by radical surgery.The efficacy and toxicity of SEEOX regimen would be examined.

Inclusion Criteria:

• histologically confirmed gastric adenocarcinoma;
• males or females, aged 30-70 years;
• gastroscopy and abdominal computed tomography (CT) scan-confirmed typical scirrhous gastric cancer (without definitive ulceration) that invaded more than half of the stomach;
• no peritoneal metastasis confirmed by laparoscopic exploration and with cytological examination of peritoneal washing of the Douglas pouch;
• eastern Cooperative Oncology Group performance status of 0 or 1;
• no serious concomitant diseases that make survival period < 3 years;
• no prior anti-tumor therapy;
• have signed informed consent before the beginning of treatment.

Exclusion Criteria:

• patients can not bear surgical procedure;
• pregnant or lactating women;
• previous cytotoxic chemotherapy, radiotherapy or immunotherapy;
• with peritoneal metastasis or distant metastasis;
• history of another malignancy within the last five years;
• history of uncontrolled seizures, central nervous system disorders or psychiatric disability judged by the Investigator to be clinically significant precluding informed consent or interfering with compliance for oral drug intake;
• clinically significant (i.e. active) cardiac disease e.g. symptomatic coronary artery disease, New York Heart Association (NYHA) grade II or greater congestive heart failure or serious cardiac arrhythmia requiring medication or myocardial infarction within the last 12 months;
• organ allografts requiring immunosuppressive therapy;
• serious uncontrolled intercurrent infections or other serious uncontrolled concomitant disease;
• moderate or severe renal impairment: serum creatinine > 1.5 x upper limit of normal (ULN);
• hypersensitivity to any drug of the study regimen;
• unwilling or unable to comply with the protocol for the duration of the study.