Safety and efficacy of systemic chemotherapy plus PD-1 inhibitor in combination with intravenous or intraperitoneal bevacizumab in gastric cancer with peritoneal metastasis

Sep 23, 2026

Background: Peritoneal metastasis in gastric cancer drives life-threatening risk through frequent treatment failure and relapse, making improved strategies urgent. This open-label two-arm pilot study assessed efficacy and safety of systemic chemotherapy combined with a PD-1 inhibitor plus bevacizumab given either intravenously or intraperitoneally. Methods: Patients received albumin-bound paclitaxel with S-1 plus sintilimab and bevacizumab, with route determined by ascites status. Results: Arm A showed mPFS 5.70 m and mOS 8.43 months; Arm B mPFS 9.07 m and mOS 11.23 months. Conclusions: The regimen was well tolerated with clinically meaningful outcomes and manageable adverse events.

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CategoryHealthcare

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Abstract

Background

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Introduction

Ma etal. BMC Cancer (2025) 25:1010 BMC Cancer [https://doi.org/10.1186/s12885-025-14206-9](https://doi.org/10.1186/s12885-025-14206-9) RESEARCH Open Access Safety and efficacy of systemic chemotherapy plus PD-1 inhibitor in combination with intravenous or intraperitoneal bevacizumab in gastric cancer with peritoneal metastasis Yuxi Ma 1,2,3, Yuting Li 1,2,3, Zhenyu Lin 1,2,3, Jing Wang 1,2,3, Jianli Hu 1,2,3, Hongli Liu 1,2,3, Yali Yang 1,2,3, Junli Liu 1,2,3* and Tao Zhang 1,2,3* Abstract Background For gastric cancer patients, peritoneal metastasis poses a life-threatening risk due to the high incidence of treatment failure and disease recurrence. Conducting additional research aimed at identifying more efficacious strategies is imperative for enhancing treatment outcomes. This study examined the efficacy and safety of systemic chemotherapy plus a PD-1 inhibitor combination with intravenous or intraperitoneal bevacizumab for gastric cancer with peritoneal metastasis. Methods We conducted the open label, two-arm pilot study involved receiving albumin-bound paclitaxel (260 mg/ m2, d1) plus S-1 (80 mg/m2, d1-14) combined with sintilimab (200 mg, d1) and bevacizumab (7 . 5 mg/m2, d1) (Arm A) intraperitoneal ly for moderate or large ascites or intravenously (Arm B) for non-or small ascites. The clinical trial was registered at the Chinese Clinical Trial Registry (ChiCTR2100048947 DATE: 2021-07-19) . Results Ten gastric cancer patients with peritoneal metastasis were enrolled in two arms (four in Arm A and six in Arm B) from August 19th, 2021 to June 1st, 2022. Until the end of the follow-up date, the mPFS for Arm A was 5.70 m (95% CI: 1.29–10. 11), while Arm B had a mPFS of 9.07 m (95% CI: 3 .79–14. 35) . The mOS for Arm A and Arm B was 8.43 (95% CI: 6 .70-10. 17) and 11.23 months (95% CI: 2 .90-19. 56) . At least one common Grade 3/4 AE occurred in 25% of Arm A participants and 16. 7% of Arm B patients. Conclusions Albumin-bound paclitaxel plus S-1 with a PD-1 inhibitor and intraperitoneal or intravenous bevacizumab was well tolerated in gastric cancer patients with peritoneal metastasis. *Correspondence: Junli Liu [junli78@foxmail.com](junli78@foxmail.com)[ ](junli78@foxmail.com)Tao Zhang [taozhangxh@hust.edu.cn](taozhangxh@hust.edu.cn) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Condensed abstract The administration of albumin-bound PTX plus S-1 with PD-1 inhibitor in conjunction with intraperitoneal or intravenous bevacizumab represents a secure and effective therapeutic approach for individuals with advanced GC featuring PM. Keywords Gastric cancer, Peritoneal metastasis, Chemotherapy, Sintilimab, Bevacizumab Introduction With a grim prognosis, peritoneal metastases (PM) are detected in 30% of cases of advanced gastric cancer (GC), for which conventional treatments such as systemic chemotherapy and i

FAQs

What clinical question does the study address for gastric cancer patients with peritoneal metastasis?

It evaluates whether combining systemic chemotherapy with a PD-1 inhibitor and bevacizumab, delivered intravenously or intraperitoneally, improves efficacy and safety for gastric cancer with peritoneal metastasis.

How were patients assigned to Arm A versus Arm B?

Arm A received intraperitoneal bevacizumab for moderate or large ascites, while Arm B received intravenous bevacizumab for non- or small ascites.

What were the key efficacy outcomes reported for progression-free survival and overall survival?

mPFS was 5.70 months in Arm A and 9.07 months in Arm B; mOS was 8.43 months in Arm A and 11.23 months in Arm B.

Sep 23, 2026

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