The FLOT4 trial published in 2019 changed the perioperative chemotherapy regimen for resectable gastric/gastro-oesophageal junction (GEJ) adenocarcinoma. Which of the following best summarises the findings?
- A FLOT (5-FU, leucovorin, oxaliplatin, docetaxel) was inferior to ECF (epirubicin, cisplatin, 5-FU) for perioperative chemotherapy
- B FLOT improved median overall survival (50 vs. 35 months) and increased pathological complete response rates compared to ECF/ECX, establishing FLOT as the new perioperative standard ✓
- C FLOT had equivalent efficacy to ECF but significantly more haematological toxicity without survival benefit
- D FLOT is recommended only in the adjuvant setting after R0 resection, not preoperatively
Correct answer: B. FLOT improved median overall survival (50 vs. 35 months) and increased pathological complete response rates compared to ECF/ECX, establishing FLOT as the new perioperative standard
Explanation
The phase III FLOT4 trial (Al-Batran et al., 2019) demonstrated that perioperative FLOT (4 cycles pre- and 4 cycles post-surgery) significantly improved median overall survival (50 months vs. 35 months) and 5-year OS (45% vs. 36%) compared to ECF/ECX in patients with resectable gastric or GEJ adenocarcinoma. FLOT also achieved higher pathological complete response rates (15–16% vs. 6%). While FLOT has more haematological toxicity (particularly neutropenia), it replaced ECF/ECX as the standard perioperative regimen in Europe for fit patients.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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