# MATTERHORN: perioperative durvalumab with FLOT chemotherapy for resectable gastric and gastro-oesophageal junction cancer

Source: https://onco.cc/key-papers/paper-matterhorn-nejm-2025/  
OnCo record `paper-matterhorn-nejm-2025` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Adding durvalumab to perioperative FLOT chemotherapy for operable stomach cancer reduced recurrences and doubled the rate of complete pathological response, the first immunotherapy to improve outcomes in curable gastric cancer.

## Summary

Phase 3 placebo-controlled trial of 948 patients with resectable stage II to IVA gastric or gastro-oesophageal junction adenocarcinoma randomised to perioperative FLOT with durvalumab or placebo, followed by durvalumab or placebo maintenance.

Event-free survival at 24 months was 67.4 versus 58.5 percent (hazard ratio 0.71), pathological complete response 19 versus 7 percent, and an interim overall survival analysis favoured durvalumab; surgery rates and toxicity were similar between arms.

## Fields

- Kind: Key paper
- Last checked: 2026-09-17
- Journal: New England Journal of Medicine
- Year: 2025
- DOI: 10.1056/NEJMoa2503701
- Authors: Janjigian YY, Al-Batran SE, Wainberg ZA, et al.
- Findings: 24-month event-free survival 67.4 percent vs 58.5 percent; hazard ratio 0.71.; Pathological complete response 19 percent vs 7 percent.
- What it means: Perioperative durvalumab with FLOT is a new standard for resectable gastric and junctional adenocarcinoma irrespective of PD-L1 expression.
- Caveats: Overall survival analysis interim.; Applicability to Asian populations receiving adjuvant-only chemotherapy is uncertain.

## Sources

- N Engl J Med 2025: https://doi.org/10.1056/NEJMoa2503701
- PubMed: https://pubmed.ncbi.nlm.nih.gov/40454643/

## Connected records

- cancers: [PD-L1-high gastric cancer](https://onco.cc/cancers/gastric-pdl1-high/)
- drugs: [Durvalumab](https://onco.cc/drugs/durvalumab/)
- trials: [MATTERHORN](https://onco.cc/trials/matterhorn/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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