Home Parenteral Nutrition for Malnourished Unresectable Stage IV Gastric Cancer

Inclusion Criteria:

1. Histology confirmed adenocarcinoma of stomach.
2. Stage IV (AJCC 7.0)
3. Malnourished patients with nutritional risk index (NRI) \< 97.5. NRI= 1.59 x serum albumin level (g/L) + 0.417 x (current weight/usual weight) x 100
4. Adequate organ function as defined by the following criteria:

   * absolute neutrophil count (ANC) \> or =1500 cells/mm3;
   * platelets \> or =60,000 cells/mm3
   * hemoglobin \> or =8.0 g/dL
   * AST and ALT \< or =3.0 x upper limit of normal (ULN), unless there are liver metastases in which case AST and ALT\< or =5.0 x ULN;
   * total bilirubin \< or =2.0x ULN
   * serum creatinine \< or =2.0 x ULN or calculated creatinine clearance \> or =60 mL/min
5. Male or female, age \> or = 20 years and \< 80 years.
6. Women of childbearing potential must have a negative serum or urine pregnancy test within 3 days prior to treatment.
7. Signed and dated informed consent document indicating that the patient (or legally acceptable representative) has been informed of all pertinent aspects of the trial prior to enrollment.

Exclusion Criteria:

1. Known allergy to components of studied parenteral nutrition.
2. Acute shock or collapse.
3. Known diabetic ketoacidosis 7 days prior to randomization.
4. Unstable conditions (e.g. uncompensated diabetes mellitus, acute myocardial infarction, embolism, metabolic acidosis, severe sepsis and hypotonic dehydration).
5. General contraindications to infusion therapy: acute pulmonary edema, hyperhydration, uncompensated cardiac insufficiency.
6. Investigator judges as subjects to be inappropriate for the clinical study (e.g., patient with severe complications)
7. Active seizure disorder or evidence of brain metastases, spinal cord compression, or carcinomatous meningitis.
8. Known human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) related illness.
9. Participation in another clinical study with an investigational drug or an investigational medical device within 1 month prior to start of the study or during the study.
10. Female patients who are pregnant or lactating, or men and women of reproductive potential not willing or not able to employ an effective method of birth control/contraception to prevent pregnancy during treatment and for 6 months after discontinuing study treatment. The definition of effective contraception should be in agreement with local regulation and based on the judgment of the principal investigator or a designated associate.