<p>Docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil (FLOT) as preoperative and postoperative chemotherapy compared with surgery followed by chemotherapy for patients with locally advanced gastric cancer: a propensity score-based analysis</p>

Abstract

Introduction: Docetaxel, oxaliplatin, leucovorin, and 5-fluorouracil (FLOT) may improve overall survival (OS) in patients with locally advanced gastric cancer (LAGC); however, evidence for its use as a standard treatment has not been established in China. The aim of this study was to investigate the effectiveness, safety, and feasibility of the FLOT regimen as neoadjuvant chemotherapy in Chinese patients with resectable LAGC. Methods: We conducted an observational study to compare the effectiveness of FLOT regimen consisting of docetaxel (60 mg/m 2 ), oxaliplatin (85 mg/m 2 ), leucovorin (200 mg/m 2 ), and 5-fluorouracil (2,600 mg/m 2 as a 24 hr infusion), all given on day 1 and administered every 2 weeks versus initial surgery followed by chemotherapy in patients with clinical T3–4 LAGC. OS was compared by using the Cox proportional hazards regression model and the Kaplan–Meier curve adjusted by inverse probability of treatment weighting (IPTW) and propensity score-matched (PSM) analysis. In addition, we performed subgroup analyses to determine the effectiveness of the FLOT regimen in clinically relevant patient subsets. Results: Overall, 47 patients who received initial FLOT chemotherapy and 269 patients who received initial surgery were enrolled in this study. In the PSM analysis, the FLOT-first group showed favorable OS compared with the surgery-first group (41 vs 41 [HR, 0.416; 95% CI, 0.218–0.794; P =0.008]), and 3-year survival rates were 58.7% and 30.9% in the FLOT-first group and surgery-first group, respectively. IPTW analysis showed similar results. However, the effect of FLOT was low (HR, 0.868; 95 CI%, 0.215–3.504) in patients without lymph node metastasis. Conclusion: Our study suggests that preoperative FLOT chemotherapy is safe and feasible. In terms of OS, FLOT may be superior to initial surgery followed by chemotherapy in reducing morbidity with resectable LAGC.

Neoadjuvant FLOT versus SOX phase II randomized clinical trial for patients with locally advanced gastric cancer

“…Recent small-scale studies from China also suggested that the FLOT regimen was safe and feasible in Chinese patients 9,10 . A propensity-scorematched retrospective study from China also suggested that patients with neoadjuvant FLOT had improved overall survival compared with patients who underwent surgery first 18 . The results of these studies suggested that the FLOT regimen was beneficial to locally advanced gastric cancer in terms of pathological regression and survival.…”

Perioperative FLOT chemotherapy plus surgery for oligometastatic esophagogastric adenocarcinoma: surgical outcome and overall survival

“…Prognostic factors were pT- staging, regression grading and type of recurrence. Although some studies suggest significant influence of age, gender, sex, tumor location and nodal stage [ 2 , 8 , 13 , 34 ] a significance could not be reproduced for patients with oligometastatic disease from EGAC. The results found in the available literature are highly heterogeneous, thus a clear recommendation of treatment for oligometastatic disease from EGAC is difficult to construct.…”

“…Different randomized controlled trials (RCT) have demonstrated superior results of perioperative chemotherapy plus surgery for non-metastatic esophagogastric cancers (EGAC) compared to surgery alone [1][2][3][4]. The chemotherapy of choice in Europe is the FLOT regime, consisting of Docetaxel 50 mg/m 2 , Oxaliplatin 85 mg/m 2 , Leucovorin 200 mg/m 2 and 5FU 2600 mg/ m 2 .…”

Perioperative FLOT Chemotherapy Plus Surgery for Oligometastatic Esophagogastric Adenocarcinoma: Surgical Outcome and Overall Survival

“…Prognostic factors were pT-staging, regression grading and type of recurrence. Although some studies suggest signi cant in uence of age, gender, sex, tumor location and nodal stage [2,8,13,33] a signi cance could not be reproduced for patients with oligometastatic disease from EGAC.…”

“…Not applicable Background Different randomized controlled trials (RCT) have demonstrated superior results of perioperative chemotherapy plus surgery for non-metastatic esophagogastric cancers (EAGC) compared to surgery alone [1][2][3][4]. The chemotherapy of choice in Europe is the FLOT regime, consisting of Docetaxel 50 mg/m², Oxaliplatin 85 mg/m², Leucovorin 200 mg/m² and 5FU 2600 mg/m².…”