Transarterial infusion chemotherapy and embolization as a novel neoadjuvant therapy for locally advanced gastric cancer: a prospective single-arm pilot study

Currently, there is limited evidence for the application of interventional therapy in the treatment of hollow viscera tumors. This prospective, single-arm, pilot study (NCT05396326) evaluated the efficacy and safety profile of transarterial infusion chemotherapy and embolization (TAICE) as a novel pre-operative treatment for locally advanced gastric cancer (LAGC) and explored its potential anti-tumor mechanisms. Twenty patients were enrolled in this study. The pathological complete response (pCR) and major pathological response (MPR) rates were 55.0% and 70.0%, respectively, and the safety profile was manageable. Patients with lower tumor residual rates showed a lower risk of recurrence, and angiographic tumor feeding artery patterns showed an association with postoperative progression-free survival. Exploratory spatial transcriptomic analyses suggested that TAICE may be associated with enhanced endoplasmic reticulum stress, altered tumor epithelial cell states, and increased intercellular communication within the tumor microenvironment. Overall, these preliminary findings suggest that TAICE may represent a complementary pre-operative locoregional strategy for selected patients with LAGC, especially those with branching tumor feeding arteries. Further investigation in prospective controlled trials with larger sample sizes is necessary.