SisterinLaw, I do understand the good intentions of his oncologist --some patients pursue HIPEC hoping it will be a cure, for certain cancers... and for most stage IV cancers, when they are not resectable, there is no current cure (only recently, with immunotherapies, doctors start to talk about 'long term remissions'/ durable responses). So, some doctors feel the need to confront them with such reality, while others won't say a word if they are not explicitly asked about prognosis/ timeline, etc.
Said that: everything changes, sometimes, from one month to the other, in terms of treatments.
In this case: the article she wrote is from 2012. Even if most of what she states is still true, in general terms, in the particular case of gastric cancer, many things happened. In 2014, at the National Institutes of Health (Bethesda, Maryland), a clinical trial, NCT00941655, finished and demonstrated the advantages of HIPEC for gastric cancer in certain cases. The article published:
J Surg Oncol. 2014 Sep;110(3):275-84. doi: 10.1002/jso.23633. Epub 2014 Jul 5.Impact of maximal cytoreductive surgery plus regional heated intraperitoneal chemotherapy (HIPEC) on outcome of patients with peritoneal carcinomatosis of gastric origin: results of the GYMSSA trial.
Rudloff U1, Langan RC, Mullinax JE, Beane JD, Steinberg SM, Beresnev T, Webb CC, Walker M, Toomey MA, Schrump D, Pandalai P, Stojadinovic A, Avital I.
A prospective randomized trial was conducted to compare the impact of systemic chemotherapy versus multi-modality therapy (complete cytoreductive surgery (CRS), hyperthermic intraperitoneal chemotherapy (HIPEC), and systemic chemotherapy) on overall survival (OS) in patients with gastric carcinomatosis.
Patients with measurable metastatic gastric adenocarcinoma involving the peritoneum, and resectable to "no evidence of disease" were randomized to gastrectomy, metastasectomy, HIPEC, and systemic FOLFOXIRI (GYMS arm) or FOLFOXIRI alone (SA arm).
Seventeen patients were enrolled (16 evaluable); 7 of 9 patients in the multi-modality GYMS arm achieved complete cytoreduction (CCR0). Median OS was 11.3 months in the GYMS arm and 4.3 months in the SA arm. Four patients in the GYMS arm survived >12 months, 2 patients close to 2 years at last follow-up, and 1 patient more than 4 years, with 2 of these patients still alive. No patient in the SA arm lived beyond 11 months. All patients surviving beyond 12 months in the surgery arm achieved complete cytoreduction and had an initial Peritoneal Cancer Index (PCI) of ≤ 15.
Maximal cytoreductive surgery combined with regional (HIPEC) and systemic chemotherapy in selected patients with gastric carcinomatosis and limited disease burden can achieve prolonged survival. http://onlinelibrary.wiley.com/doi/10.1 ... 562.f04t03
Based on that and other results from ongoing research, there is a new ongoing, recruiting trial at the NIH:Heated Intraperitoneal Chemotherapy and Gastrectomy for Gastric Cancer With Positive Peritoneal Cytology
*However*, patient need to have received a first line of chemo first. BUT there is other important trial at the NHI, that I would recommend: they are taking samples to find tailored, personalized treatments: Prospective Evaluation and Molecular Profiling in People With Gastric Tumors
: NCT03027427 https://clinicaltrials.gov/ct2/show/NCT03027427
Determining molecular profile, mutations, etc. is *fundamental*, these days. It is fundamental for other important immunotherapy trials ongoing at NIH (like NCT01174121, Immunotherapy Using Tumor Infiltrating Lymphocytes for Patients With Metastatic Cancer, or NCT03190941, Administering Peripheral Blood Lymphocytes Transduced With a Murine T-Cell Receptor Recognizing the G12V Variant of Mutated RAS in HLA-A*1101 Patients ) BUT also just because the standard of care is changing, month to month
. For example, one month ago, there was not immunotherapy approved for gastric cancer. But... past September 22th:
The US Food and Drug Administration (FDA) today approved pembrolizumab (Keytruda, Merck) for treatment of gastric or gastroesophageal junction cancer. Pembrolizumab becomes the first immunotherapy approved in the United States for gastric cancer.
The approval is limited to patients who have had at least two previous lines of chemotherapy for these recurrent locally advanced or metastatic adenocarcinomas that express programmed death receptor-ligand 1 (PD-L1).
Again, your brother in law can't get Keytruda right now if he has not prior lines of treatment, per the standard of care. BUT that time will come. And if he wants to try it right now, he even could opt out from more standard treatment --chemo-- and look for a clinical trial where get anti PD-1 --immunotherapy--, like this in Chicago:
A Phase 1/2 Study Exploring the Safety, Tolerability, and Efficacy of Pembrolizumab (MK-3475) in Combination With Epacadostat (INCB024360) in Subjects With Selected Cancers (INCB 24360-202 / MK-3475-037 / KEYNOTE-037/ ECHO-202) https://clinicaltrials.gov/ct2/show/study/NCT02178722
or this at Sloan Kettering NY: A Study to Test Combination Treatments in Patients With Advanced Gastric Cancer (FRACTION-GC) https://clinicaltrials.gov/ct2/show/study/NCT02935634
Hope this helps.