SummaryBackground: Malignant ascites is a frequent complication in gastrointestinal malignancy and is unresponsive to systemic therapies. Therapeutic options are limited, and repeated paracentesis is associated with increased loss of fluids and proteins, and impaired quality of life. The bi-specific trifunctional antibody catumaxomab has been approved for the treatment of refractory ascites. It has been proposed that repeated application leads to formation of human anti-mouse antibodies with a decrease in effectiveness and potentially hypersensitivity reactions. Case Report: Here we report on the repeated application of catumaxomab in 2 patients with advanced signet cell gastric cancer. Repeated application was safe and effective in decreasing the frequency of paracentesis in 1 patient. No hypersensitivity reactions beyond the immune-mediated side effects were observed with the application of catumaxomab. 1 patient experienced an inflammatory response with acute deterioration of kidney function during the first cycle but recovered quickly. Re-challenge with catumaxomab did not produce an inflammatory reaction in the 2 cases. Conclusion: Overall, the repeated treatment was associated with a beneficial effect on puncture-free survival in 1 patient, and appears to be a treatment option in selected patients with gastrointestinal malignancy.

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