ESMO guideline now includes FLOT for gastric cancer

  • European Society for Medical Oncology

  • Oncology guidelines update
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Takeaway

  • An update to 2016 guidelines for treatment of stage Ib or greater resectable gastric and gastroesophageal junction cancer recommends perioperative treatment with 5-fluorouracil/leucovorin, oxaliplatin, and docetaxel (FLOT).

Why this matters

  • The update reflects a change to the standard of care for gastric cancer and gastroesophageal junction cancer.

Key points

  • The updated recommendations come from a recent report from the FLOT4 trial, previously covered here.
  • Perioperative FLOT yielded a higher pathological response rate (15.6% vs 5.8%) and extended OS (50 vs 35 months; HR, 0.77, P=.012) vs standard care (epirubicin, cisplatin, and 5-fluorouracil or capecitabine) in patients with resectable gastric cancer.
  • There were no major toxicity concerns with the FLOT regimen.
  • Updated guidelines recommend FLOT as the standard of care, unless there is a specific contraindication for components of FLOT or the patient is not a good candidate for triplet therapy.
  • Biological targeted drugs, such as trastuzumab, or antiangiogenic drugs are not supported for perioperative use.

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