Peritoneal carcinomatosis originating from gastric/gastroesophageal junction cancer (GC-PC) occurs in a defined subset of gastric cancer patients with unique clinical, pathologic, molecular and immunologic characteristics that create significant obstacles to effective treatment with modern therapy. Although systemic chemo- and immuno- therapy have yielded disappointing results in GC-PC, recent advances in the characterization of GC-PC and peritoneal immune biology present new opportunities for targeted therapeutics. In this review article, we discuss the distinct properties of GC-PC and the peritoneal immune environment as they pertain to current and investigative treatment strategies. We discuss pre-clinical studies and clinical trials relevant to the modulation of the peritoneal environment as a therapeutic intervention in GC-PC. Finally, we present a road map for future combinatorial strategies based on the conception of the peritoneal cavity as a bioreactor. Within this isolated compartment, prevailing immunosuppressive conditions can be altered through regional interventions toward an adaptive phenotype that would support the effectiveness of regionally delivered cellular therapy products. It is hoped that novel combination strategies would promote efficacy not only in the sequestered peritoneal environment, but also via migration into the circulation of tumor-reactive lymphocytes to produce durable systemic disease control, thereby improving oncologic outcome and quality of life in patients with GC-PC.
源自胃/胃食管结合部癌的腹膜癌病（GC-PC）发生于具有特定临床、病理、分子及免疫学特征的胃癌患者亚群，这些特征对现代疗法的有效治疗构成显著障碍。尽管系统性化疗与免疫疗法在GC-PC治疗中效果不尽如人意，但近期在GC-PC特征描述及腹膜免疫生物学方面的进展为靶向治疗提供了新机遇。本文综述了GC-PC的独特性质及其所处的腹膜免疫环境，并探讨其与当前及研究性治疗策略的关联。我们讨论了通过调节腹膜环境作为GC-PC治疗干预手段的相关临床前研究及临床试验。最后，基于将腹膜腔视为生物反应器的理念，我们提出了未来联合治疗策略的发展路径。在这个相对隔离的腔室内，可通过局部干预改变普遍存在的免疫抑制状态，使其向适应性表型转化，从而支持区域性输注细胞治疗产品的有效性。新型联合策略有望不仅在隔离的腹膜环境中提升疗效，还能通过肿瘤反应性淋巴细胞迁移至循环系统实现持久的全身性疾病控制，从而改善GC-PC患者的肿瘤学预后与生活质量。
肿瘤(癌症)患者之家