Jaffer A. Ajani, MD
Jaffer A. Ajani, MD, Professor of Medicine in the Department of Gastrointestinal Oncology at The University of Texas MD Anderson Cancer Center, told The ASCO Post that obesity (defined as high body mass index of 30–39.9 kg/m2) is increasing around the globe; by 2035, more than 50% of adults will be obese, based on one estimate. “This projection is very concerning,” said Dr. Ajani, who noted that proximal gastric cancer is associated with obesity and overweightness.
According to Dr. Ajani, proximal gastric cancer does not commonly disseminate in the peritoneal cavity. Extracellular vesicles are known to promote cancer growth and facilitate metastatic niche, Dr. Ajani noted, and this phenomenon is entirely dependent on the payload extracellular vesicles carry.
“Rubin et al described extracellular vesicles from adipose tissue of ‘obese’ patients (adipocytes are well known to produce inflammation-causing cytokines that are not good for the host and may result in multiple chronic diseases but also cancer) facilitating progression of peritoneal gastric cancer,” said Dr. Ajani. “This is interesting, but it remains unclear which payload is responsible.”
“Further research may establish whether a particular payload (a specific inflammatory cytokine) could be inhibited and might alter the course of peritoneal carcinomatosis,” Dr. Ajani continued. “Gastric cancer–induced peritoneal carcinoma creates an immunosuppressive milieu (favoring the cancer and not the host), and it would be challenging to overcome progression of peritoneal carcinoma by targeting one molecule.”
“It would be interesting to understand how many cases were studied and how these experiments were done,” Dr. Ajani concluded. “However, it is clear that gastric carcinoma associated with peritoneal carcinomatosis is a special unmet need, and all efforts to address this are welcome.”
DISCLOSURE: Dr. Ajani has received honoraria from Acrotech, Aduro Biotech, Amgen, Astellas Pharma, AstraZeneca, BeiGene, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, DAVA Pharmaceuticals, Gilead Sciences, Grail, Kabi, Lilly, Merck, Novartis, Oncotherics, Servier, and Zymeworks; has served in a consulting or advisory role for the American Cancer Society, Amgen, Arcus Biosciences, Astellas Pharma, BeiGene, Bristol-Myers Squibb, Geneos, Gilead Sciences, Insys Therapeutics, Merck, Novartis, Servier, and Vaccinogen; and has received research funding from Amgen, Astellas Pharma, Bristol-Myers Squibb, Daiichi Sankyo, Delta-Fly Pharma, Gilead Sciences, Lilly/ImClone, MedImmune, Merck, Novartis, Prolinx, Roche/Genentech, Taiho Pharmaceutical, Takeda, and Zymeworks.
