{"entity":{"id":"paper-flot4-lancet-2019","kind":"paper","name":"FLOT4-AIO: perioperative FLOT versus ECF/ECX for resectable gastric or gastro-oesophageal junction adenocarcinoma","aka":[],"tldr":"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).\n\nMedian 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.","asOf":"2026-09-17","links":[{"label":"Lancet 2019","url":"https://doi.org/10.1016/S0140-6736(18)32557-1"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/30982686/"}],"tags":[],"related":[],"cancers":["oesophageal-adenocarcinoma","gastric-pdl1-high","gastric-her2-positive"],"sections":[],"technologies":[],"targets":[],"drugs":["capecitabine","cisplatin","docetaxel","epirubicin","oxaliplatin"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["flot4"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["lancet"],"dependsOn":[],"notes":[],"journal":"The Lancet","year":2019,"doi":"10.1016/S0140-6736(18)32557-1","pmid":"30982686","authors":"Al-Batran SE, Homann N, Pauligk C, et al.","paperType":"rct","findings":["Median overall survival 50 vs 35 months; hazard ratio 0.77.","Five-year overall survival 45 percent vs 36 percent."],"whatItMeans":"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."],"changedPractice":true,"participants":716},"route":"/key-papers/paper-flot4-lancet-2019/","neighbours":{"cancer":[{"id":"gastric-her2-positive","kind":"cancer","name":"HER2-positive gastric cancer","route":"/cancers/gastric-her2-positive/"},{"id":"oesophageal-adenocarcinoma","kind":"cancer","name":"Oesophageal and junctional adenocarcinoma","route":"/cancers/oesophageal-adenocarcinoma/"},{"id":"gastric-pdl1-high","kind":"cancer","name":"PD-L1-high gastric cancer","route":"/cancers/gastric-pdl1-high/"}],"drug":[{"id":"capecitabine","kind":"drug","name":"Capecitabine","route":"/drugs/capecitabine/"},{"id":"cisplatin","kind":"drug","name":"Cisplatin","route":"/drugs/cisplatin/"},{"id":"docetaxel","kind":"drug","name":"Docetaxel","route":"/drugs/docetaxel/"},{"id":"epirubicin","kind":"drug","name":"Epirubicin","route":"/drugs/epirubicin/"},{"id":"oxaliplatin","kind":"drug","name":"Oxaliplatin","route":"/drugs/oxaliplatin/"}],"trial":[{"id":"flot4","kind":"trial","name":"FLOT4-AIO","route":"/trials/flot4/"}],"journal":[{"id":"lancet","kind":"journal","name":"The Lancet","route":"/journals/lancet/"}]}}