Peritoneal-directed therapy for gastric cancer

Gastric cancer most often recurs on the peritoneum, where systemic drugs barely reach, so this idea proposes delivering treatment directly into the abdomen. Candidates include intraperitoneal paclitaxel with systemic chemotherapy, which PHOENIX-GC narrowly missed and Japanese trials are pursuing, PIPAC, and regionally delivered CLDN18.2 CAR-T such as satricabtagene autoleucel. The rationale is the pharmacokinetic advantage of intraperitoneal delivery and the fact that peritoneal-only disease is a distinct, chemoresistant compartment that staging laparoscopy can identify early. The proposed test is a randomised phase 3 restricted to peritoneal-only disease, and at an early clinical stage it addresses the bottleneck that metastasis is understood least and studied last.