New NUH trial holds out hope for gastric cancer patients

SINGAPORE - When cancer spreads into the lining of the abdomen, patients usually have fewer than six months to live, even with chemotherapy.

But a new way of delivering anti-cancer drugs, now being tested at National University Hospital (NUH), could offer hope even to patients with final-stage gastric cancer.

It involves sending the chemotherapy drug straight into the abdominal cavity via a tube inserted in the body. This is much like how dialysis fluid is fed into the abdomen of kidney patients, also using a tube.

Clinical trials of this new method are now being carried out by NUH doctors to see if, coupled with the standard treatment of chemotherapy injections and pills, it will help late-stage cancer patients live longer.

The trial, involving 30 patients, is the first of its kind here and is expected to end in 2015.

Gastric cancer ranks among the top 10 cancers in Singapore, with 500 new cases a year.

Six in 10 have their disease discovered at a late stage, by which time the cancer has often spread to the lining of the abdomen, known as the peritoneum. Most die within three to six months, said Associate Professor Jimmy So, who is involved in the NUH trial.

"With the new method, they have a better chance," said the senior consultant in the hospital's general surgery division.

A similar trial in Japan has shown promising results, with about 80 per cent of patients living for at least one year.

But the drug taken by the Japanese, called TS1, is hardly used in Singapore.

The NUH trial uses the drug paclitaxel. It has long been given as an injection to gastric cancer patients, as well as to treat cancers of the breast, ovary and lung.

But it is not easily absorbed by the body.

Side effects, such as low blood count and nerve damage, can also be a problem.

So, sending the drug directly into the peritoneum minimises the side effects, said Dr Yong Wei Peng of the National University Cancer Institute, Singapore, who is the leader of the NUH trial.

Mr Seet Kok Tiong, 63, is one of the first seven patients to start on the new method.

The side effects have been minimal so far, he said. "The second time, I vomited a little and had diarrhoea, but I was fine after taking some medicine," said the carpentry works coordinator who has Stage 4 gastric cancer.

About 30 per cent of patients with late-stage gastric cancer like Mr Seet's can benefit from the new method, said Dr Yong.

Those with liver and kidney ailments, for example, are not suitable because their bodies have detoxification problems, he added.

Meanwhile, Mr Seet, who has several rounds of chemotherapy to go, said: "I feel like I'm back to normal already.

"My appetite is good and I can climb the stairs up four storeys without getting breathless."

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