- The superiority of docetaxel-based triplet pre-operative therapy (docetaxel., oxaliplatin, leucovorin, and 5-fluorouracil [FLOT regimen]) over standard care (epirubicin, cisplatin, and 5- fluorouracil or capecitabine [ECF/ECX regimen]) in patients with resectable gastric cancer has been confirmed by a multivariate, subgroup, and sensitivity analysis of the FLOT4 study.
- FLOT regimen should be considered the new standard of care in the perioperative treatment of patients with resectable gastric or gastroesophageal junction adenocarcinoma.
Why this matters
- In previous studies, FLOT was superior to ECF/ECX for all efficacy endpoints, including curative resection rates, progression-free survival, and overall survival.
- This study demonstrates that there are benefits also for older patients and patients with small tumours, nodal negative status, or signet cell cancer.
- In FLOT4 study, 716 patients with resectable gastric or gastroesophageal junction adenocarcinoma of stage ≥cT2 and/or cN+ were randomly assigned into 2 perioperative groups of treatment.
- Group 1 received 3 pre-operative and 3 post-operative 3-week cycles of ECF/ECX.
- Group 2 received 4 pre-operative and 4 post-operative 2-week cycles of FLOT.
- The primary endpoint was overall survival.
- FLOT was associated with a 1% of progressive disease during or after pre-operative therapy, ECF regimen with 5% (P<.001).
- FLOT guaranteed a larger number of free of disease resections (84% versus 77%; P=.011), longer progression-free time (30 months versus 18 months; HR, 0.75; P=.001) and overall survival (50 months versus 35 months; HR, 0.77; P=.012).