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Real-world delivery, toxicity and outcomes of perioperative FLOT chemotherapy in resectable gastric/gastroesophageal adenocarcinoma: A population-based study
Background
Perioperative docetaxel, oxaliplatin and fluorouracil/leucovorin (FLOT) has become the new standard of care for resectable gastric/ gastroesophageal adenocarcinoma since publication of the FLOT-AIO clinical trial. However, delivery, toxicity, and outcomes of this regimen in routine practice have not been widely studied.
Methods
Data from Surveillance and Reporting group of Cancer Control Alberta was used to obtain data of all patients with resectable gastric and GEJ adenocarcinoma, who were treated with perioperative FLOT chemotherapy in the province of Alberta, Canada between August 1, 2017 and August 1, 2020. Charts were retrospectively reviewed for baseline demographics, cumulative doses and number of cycles received, chemotherapy-related toxicities and hospitalizations, extent of surgical resection achieved and disease-free and overall survival. Toxicities were graded using CTCAE v5 criteria.
Results
In total, 48 patients met inclusion criteria. Median age of patients was 60 and 54% (26/48) were male. Of those with reported pre-treatment ECOG and clinical stage, 94% (30/32) were ECOG ≤1 and 57% (21/37) clinical stage ≤2. Ninety-six percent (46/48) of patients completed 4 cycles of pre-operative FLOT and 94% (45/48) proceeded to surgery, while only 50% (24/48) completed 4 cycles of post-operative FLOT. Twenty-nine percent (14/48) of patients required hospitalization with a chemotherapy-related toxicity, most commonly from a gastrointestinal bleed (6/14) or infection (6/14). Pathological complete response was observed in 8.3% of patients (4/48). Fifty percent of patients (24/48) experienced a grade ≥3 chemotherapy-related toxicity. There were no treatment-related fatalities. Median overall survival and disease-free survival were 26.2 and 16.5 months respectively.
Conclusions
In this real-world study, perioperative FLOT chemotherapy was feasible. Rates of treatment completion of all cycles, grade ≥3 toxicities and hospitalizations secondary to chemotherapy were high, but similar to those seen in the randomized trial. Median overall survival was considerably less than in the randomized trial, but this is likely due to short follow-up time. Further study is required to understand factors associated with completion of chemotherapy and overall survival in routine practice.
Legal entity responsible for the study
The authors.
Funding
University of Calgary.
Disclosures
All authors have declared no conflicts of interest.
