What is carcinomatosis (cancer metastasis)?

From the Guidelines

Carcinomatosis is a severe condition with a generally poor prognosis, and treatment should focus on extending survival time and improving quality of life, rather than cure, with systemic chemotherapy, targeted therapies, and immunotherapy being primary options. When considering treatment for carcinomatosis, it is essential to prioritize the patient's overall health status and the extent of cancer spread. According to the study by Pagani et al. 1, metastatic breast cancer, a type of carcinomatosis, has a heterogeneous disease presentation, ranging from solitary metastatic lesions to diffuse and multiple organ involvement. The study highlights that a distinctive subset of metastatic breast cancer patients, those with oligometastatic disease, may benefit from a more aggressive and multidisciplinary therapeutic approach, including surgery, radiotherapy, and regional chemotherapy.

Key considerations in managing carcinomatosis include:

• The primary cancer type and its potential responsiveness to treatment
• The extent of cancer spread and the number of organs involved
• The patient's overall health status and ability to tolerate aggressive treatments
• The potential benefits and risks of different treatment options, including systemic chemotherapy, targeted therapies, immunotherapy, and cytoreductive surgery with heated intraperitoneal chemotherapy (HIPEC)

As noted in the study by Pagani et al. 1, the European School of Oncology–Metastatic Breast Cancer Task Force recommends considering a more aggressive and multidisciplinary approach for patients with oligometastatic disease, which may include surgery, radiotherapy, and regional chemotherapy. However, the value of such strategies has not been tested in prospective randomized trials and is not well recognized.

In terms of prognosis, carcinomatosis is generally a serious condition with a poor outlook, but early detection of the primary cancer and prompt treatment can improve survival time and quality of life. The study by Pagani et al. 1 suggests that the risk of death from metastatic breast cancer is decreasing by 1%–2% each year, likely due to the development and widespread availability of modern systemic therapies.

Overall, the management of carcinomatosis requires a comprehensive and individualized approach, taking into account the patient's unique circumstances and the latest available evidence. Treatment should prioritize extending survival time and improving quality of life, rather than cure, with a focus on systemic chemotherapy, targeted therapies, and immunotherapy as primary options.

From the Research

Carcinomatosis Treatment Options

• The treatment of ovarian cancer often involves a combination of chemotherapy drugs, including carboplatin and paclitaxel 2.
• Studies have shown that the carboplatin/paclitaxel doublet is effective in the initial treatment of ovarian cancer, with carboplatin dosed using the Calvert formula yielding convincing noninferior outcomes compared to the prior regimen of cisplatin/paclitaxel 2.
• The use of dose-dense weekly paclitaxel with 3-weekly carboplatin has been shown to improve progression-free survival and overall survival in patients with advanced ovarian cancer, although it is associated with higher rates of side effects 3, 4.

Role of Bevacizumab in Treatment

• Bevacizumab has been shown to improve overall survival in patients with platinum-sensitive recurrent ovarian cancer when added to standard chemotherapy, followed by maintenance therapy until progression 5.
• The combination of bevacizumab, carboplatin, and paclitaxel has been shown to be effective in the first-line treatment of advanced ovarian cancer patients, with clinical factors such as performance status, stage, and residual disease after primary surgery being significant predictors of progression-free and overall survival 6.

Chemotherapy Regimens

• Different chemotherapy regimens, including weekly carboplatin and paclitaxel, have been shown to be effective in the treatment of ovarian cancer, with varying rates of side effects and efficacy 3, 4.
• The choice of chemotherapy regimen may depend on patient tolerance and comorbidities, as well as the specific characteristics of the cancer 2, 6.