FLOT4-AIO: perioperative FLOT versus ECF/ECX for resectable gastric or gastro-oesophageal junction adenocarcinoma
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.
Overview
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.
- Median overall survival 50 vs 35 months; hazard ratio 0.77.
- Five-year overall survival 45 percent vs 36 percent.
FLOT is the reference perioperative regimen for gastric and junctional adenocarcinoma, and the backbone onto which durvalumab was added in MATTERHORN.
- Only about half of patients completed postoperative chemotherapy.
- Not compared with CROSS chemoradiotherapy for oesophageal adenocarcinoma until ESOPEC.
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