# FLOT4-AIO: perioperative FLOT versus ECF/ECX for resectable gastric or gastro-oesophageal junction adenocarcinoma

Source: https://onco.cc/key-papers/paper-flot4-lancet-2019/  
OnCo record `paper-flot4-lancet-2019` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Perioperative chemotherapy with docetaxel, oxaliplatin, fluorouracil and leucovorin (FLOT) lengthened survival compared with the older anthracycline-based regimen in operable stomach and junctional cancers, making FLOT the standard in Europe.

## Summary

Phase 2/3 trial of 716 patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (stage cT2 or higher or node-positive) randomised to perioperative FLOT (four cycles before and after surgery) or ECF/ECX (three cycles before and after).

Median overall survival was 50 versus 35 months (hazard ratio 0.77), five-year survival 45 versus 36 percent, and complete resection rates were higher with FLOT; toxicity profiles differed but were manageable.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: The Lancet
- Year: 2019
- DOI: 10.1016/S0140-6736(18)32557-1
- Authors: Al-Batran SE, Homann N, Pauligk C, et al.
- Findings: Median overall survival 50 vs 35 months; hazard ratio 0.77.; Five-year overall survival 45 percent vs 36 percent.
- What it means: FLOT is the reference perioperative regimen for gastric and junctional adenocarcinoma, and the backbone onto which durvalumab was added in MATTERHORN.
- Caveats: Only about half of patients completed postoperative chemotherapy.; Not compared with CROSS chemoradiotherapy for oesophageal adenocarcinoma until ESOPEC.

## Sources

- Lancet 2019: https://doi.org/10.1016/S0140-6736(18)32557-1
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30982686/

## Connected records

- cancers: [HER2-positive gastric cancer](https://onco.cc/cancers/gastric-her2-positive/), [Oesophageal and junctional adenocarcinoma](https://onco.cc/cancers/oesophageal-adenocarcinoma/), [PD-L1-high gastric cancer](https://onco.cc/cancers/gastric-pdl1-high/)
- drugs: [Capecitabine](https://onco.cc/drugs/capecitabine/), [Cisplatin](https://onco.cc/drugs/cisplatin/), [Docetaxel](https://onco.cc/drugs/docetaxel/), [Epirubicin](https://onco.cc/drugs/epirubicin/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/)
- trials: [FLOT4-AIO](https://onco.cc/trials/flot4/)
- journals: [The Lancet](https://onco.cc/journals/lancet/)

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