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e16538 Background: Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is emerging as a new intraperitoneal laparoscopic delivery of chemotherapy to treat peritoneal metastasis (PM). First results from several malignancies appear promising in small series of patients. Prognosis of PM from gastric cancer (GC) is poor. Median survival is ranging from 3 to 13 months with systemic chemotherapy (SC) alone. Purpose: to evaluate the feasibility and potential benefits of PIPAC associated to SC in GC with PM in a palliative setting Methods: From a prospective database, we identified 91 consecutive patients considered with isolated unresectable PM from GC treated by an alternance of SC and PIPAC with low-dose cisplatin-doxorubicin (ratio 2/1) between January 2016 and January 2019 in our institution. End of follow-up was January 2020. Results: Median age was 56 years, 86% of patients had a signet ring cell adenocarcinoma with 86.7% of synchronous PMs.Median Peritoneal Cancer Index was 16 (3-39). A total of 346 PIPAC were performed with a median of 3 per patient (1-18). Median number of SC lines was 3 (2-3) resulting in a median number of SC cycles of 14 (11-20). After a median follow-up of X months, 21 patients were still alive. In the whole population, median OS from diagnosis was 15.1 months. PIPAC was introduced in association to first-line SC as maintenance or intensification therapy in 75 patients with a median survival from diagnosis of 14.7 months and a median PFS from PIPAC introduction of 6.3 months. For 16 patients, PIPAC was introduced due to progression after a first or second line of SC leading to a median OS of 20 months after diagnosis and 5.9 months after PIPAC introduction. Reasons to stop PIPAC were cancer progression, intraperitoneal access difficulties or PIPAC related morbidity, a cytoreductive surgery attempt in 61.7%, 19.8% and 18.5% respectively. A cytoreduction and HIPEC attempt was performed for 12 patients before 3 PIPAC and 3 after 3 PIPAC or more, leading to a median OS of 19 months for those patients. Twelve (13,2%) patients developed extra-peritoneal metastases during PIPAC. Conclusions: PIPAC appears safe and feasible showing promising results in control of PMs from gastric origin. Further randomized studies are required to document its benefits compared to SC alone.

3037 Background: The successes of recent publications on “multi-tumor” circulating markers highlight the relevance of novel universal diagnostic cancer serum biomarkers. Since the Wnt/ß-catenin/Tcf4 pathway, activated in many tumors, induces the GAST Gene encoding progastrin synthesis, we hypothesized that progastrin, easily measurable in the blood, might be a “multi-tumor” diagnostic biomarker. Methods: Progastrin levels were measured in the blood samples of 1319 patients with 12 different cancer origins, and compared to those of 557 asymptomatic 18-75 years old blood donors. Moreover the longitudinal kinetics of progastrin concentrations were serially assessed during treatments in 168 patients with ovarian cancers enrolled in the randomized CHIVA trial (NCT01583322, GINECO), 191 patients with peritoneal involvement from gastro-intestinal cancers enrolled in BIG-RENAPE trial (NCT03787056), and in 95 HCC patients. The progastrin was measured using an ELISA test developed by ECS Progastrin (Prilly, Switzerland). Results: Compared to healthy blood donors, progastrin was found at higher concentrations in the plasma of cancer patients: median 4.47 vs 0.20 pM, P < 0.0001; diagnostic discriminative power, ROC analysis AUC = 0.86 (95% CI, 0.83-0.89; P < 0.0001). Progastrin levels were found elevated in all cancer groups, regardless of disease stages, and of pathology origins: ROC AUCs ranged from 0.71 to 0.93, all P < 0.0001 (Table). The longitudinal progastrin changes during treatments, suggest relationships to tumor burden, and potential monitoring value. Conclusions: Progastrin is a novel ubiquitous cancer biomarker, easily detectable in the blood using an affordable ELISA test (CancerRead Lab test(R)). It may change the future paradigms about screening (in particular for populations at higher or lower risks of cancer), cancer diagnostic & monitoring. [Table: see text]

149 Background: PIPAC is a recent approach for intraperitoneal chemotherapy with promising results for patients with peritoneal carcinomatosis (PC). We aimed to evaluate survival and postoperative outcome of PIPAC in patients with non-resectable PC from gastric cancer. Methods: This is a retrospective analysis. Sixty-nine PIPAC were applied in 22 consecutive patients pretreated non-resectable PC from gastric cancer. All patients had undergone previous lines of systemic chemotherapy (median, two lines). Cisplatin 7.5 mg/m2 and doxorubicin 1.5 mg/m2 were given for 30 min at 37 °C and 12 mmHg at 6-week intervals.The treatment schedule proposed alternating 2 systemic chemotherapy followed by 1 PIPAC cycles. Outcome criteria were survival, adverse events according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Results: At the time of the first PIPAC, the median PCI was 18 (1-35). Median consecutive PIPAC cycles were 4 (1-9). Survival time was 19.5 months. Major complications (CTCAE - III, IV) occurred for 6 PIPAC (8.7%) and 1 (4.5%) patients died within 30 days of the PIPAC procedure a cause related to aspiration pneumonia during the general anesthesia. Systemic chemotherapy was associated with PIPAC and could be administered after PIPAC with a median delay of 14 days (7-28). Conclusions: PIPAC with low-dose cisplatin and doxorubicin was safe and feasible in association with systemic chemotherapy. Survival data are encouraging and justify further clinical studies in this indication.

418 Background: Peritoneal metastasis from biliary carcinoma (PMC) is associated with poor prognosis when treated with chemotherapy. The objective was to evaluate the impact on survival of cytoreduction surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), and compare with conventional palliative chemotherapy for patients with PMC. Methods: A prospective multicenter international database was retrospectively searched to identify all patients with PMC treated with a potentially curative CRS/HIPEC (CRS/HIPEC group). The overall survival (OS) was compared to patients with PMC treated with palliative chemotherapy (systemic chemotherapy group). Survival was analyzed using Kaplan-Meier method and compared with Log-Rank test. Results: Between 1995 and 2015, 34 patients were included in the surgical group, and compared to 21 in the medical group. In the surgical group, median peritoneal cancer index was 9 (range 3-26), macroscopically complete resection was obtained for 25 patients (73%). There was more gallbladder localization in the surgical group compared to the medical group (35% vs. 18%, p= 0.001). Median OS was 21.4 and 9.3 months for surgical and medical group, respectively (p =0.007). Three-year overall survival was 30% and 10% for surgical and medical group, respectively. Conclusions: Treatment with CRS and HIPEC for cholangiocarcinoma with peritoneal metastasis is feasible and may provide survival benefit when compared to palliative chemotherapy.