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The abundance of immune cells in the peritoneum and ascitic fluid, along with the immunosuppressive environment created by cancer cells, suggests the potential utility of intraperitoneal (IP) immune checkpoint inhibitors for controlling malignant ascites.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with gastrointestinal or pancreaticobiliary tract cancer and cytologically confirmed malignant ascites received IP nivolumab. Twenty mg of nivolumab diluted in 100\u00a0mL of saline was infused into the peritoneal cavity over 10\u00a0min following paracentesis. IP treatment was repeated after each subsequent paracentesis until deemed ineffective by the treating physician, upon the occurrence of unacceptable toxicity, or discontinued at the patient\u2019s request. This study was registered at ClinicalTrials.gov (NCT05745233).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median age of the nine enrolled patients was 55\u00a0years. Underlying malignancies included pancreatic (n\u2009=\u20094), biliary tract (n\u2009=\u20093), and gastric cancers (n\u2009=\u20092). After a median of 3 (range: 2\u20135) treatment cycles, seven patients (77.8%) showed a clinical response, as evidenced by reduced ascitic fluid and prolonged intervals between paracenteses. The only adverse effect observed was grade 1 tenderness at the puncture sites. Reduction in tumor cell count in ascites, rather than changes in the total lymphocyte count or lymphocyte subpopulations, correlated with clinical response. Responders consistently exhibited increased vascular endothelial growth factor A and decreased interleukin-1\u03b1 levels following nivolumab administration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Intraperitoneal administration of nivolumab effectively controlled malignant ascites with minimal adverse effects. However, further validation in a larger cohort is required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10147-025-02930-y","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T12:55:02Z","timestamp":1765371302000},"page":"281-291","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Intraperitoneal nivolumab for malignant ascites in patients with advanced gastrointestinal or pancreaticobiliary tract cancer"],"prefix":"10.1007","volume":"31","author":[{"given":"Hsiu-Tzu","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yung-Luen","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Jyi","family":"Lo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mei-Chen","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chien-Lun","family":"Chu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chia-Yu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sing-Ting","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang-Fang","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"En-Jia","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7739-4077","authenticated-orcid":false,"given":"Li-Yuan","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"key":"2930_CR1","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1053\/clon.2002.0135","volume":"15","author":"EM Smith","year":"2003","unstructured":"Smith EM, Jayson GC (2003) The current and future management of malignant ascites. 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