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Modified FLOT Improves Surgical Outcomes for Patients With Gastroesophageal Junction Adenocarcinoma
For patients with gastroesophageal junction adenocarcinomas planned for curative resection, perioperative therapy with a dose-modified version of docetaxel, oxaliplatin, leucovorin, and fluorouracil (mFLOT) improved resection rates and survival with a manageable increase in toxicity, compared to epirubicin, oxaliplatin, and capecitabine (EOX).
This study included 593 patients with gastroesophageal junction adenocarcinomas receiving either perioperative mFLOT (n = 332) or perioperative EOX (n = 261) planned for curative resection, between January 2013 and December 2019. Those patients were matched on a 1:1 basis, using age, tumor location, histology, and Eastern Cooperative Oncology Group performance status. In the mFLOT and EOX groups, 86% and 76% of patients underwent curative resection, respectively (P = .002). The primary outcome was 3-year event-free survival (EFS).
There was a median follow-up duration of 53 months in the mFLOT group and 35 months in the EOX group. The 3-year EFS was statistically superior in the mFLOT group compared to the EOX group (60% vs 39%; P <.001). The incidence of grade 3/4 neutropenia and febrile neutropenia was higher in the mFLOT group compared to the EOX group.
“mFLOT is associated with improved resection rates and survival in comparison to EOX as perioperative therapy in gastric adenocarcinomas in this large real-world cohort, with manageable increase in clinically relevant toxicities such as grade 3 and grade 4 febrile neutropenia and neutropenia,” concluded study authors.
Source:
Ramaswamy A, Bhargava P, Srinivas S, et al. Perioperative modified FLOT versus EOX in locally advanced resectable gastric and gastro-oesophageal junction adenocarcinoma: Results of a matched-pair analysis. J Gastrointest Canc. Published online October 15, 2022. doi:10.1007/s12029-022-00867-3
