A 58-year-old man with stage III gastric adenocarcinoma of the gastric antrum (T3 N2 M0) is planned for surgery. The FLOT-4 trial changed the standard perioperative chemotherapy regimen. According to FLOT-4 results, which regimen offers superior overall survival compared to the earlier ECF/ECX (epirubicin-cisplatin-fluorouracil) perioperative regimen?
- A FOLFOX (oxaliplatin + leucovorin + 5-FU)
- B Cisplatin + capecitabine (XELOX) with trastuzumab
- C ECF (epirubicin + cisplatin + 5-FU) 3 cycles pre-op and 3 post-op (MAGIC protocol)
- D FLOT (docetaxel + oxaliplatin + leucovorin + 5-FU) — 4 cycles pre-op and 4 cycles post-op ✓
Explanation
The FLOT-4 trial (Al-Batran et al., NEJM 2019) demonstrated that perioperative FLOT (docetaxel 50 mg/m2 + oxaliplatin 85 mg/m2 + leucovorin 200 mg/m2 + 5-FU 2600 mg/m2; 4 cycles pre- and 4 post-operatively) significantly improved overall survival (median 50 months vs 35 months) and pathological complete response rates (15% vs 6%) compared to ECF/ECX in resectable gastric and gastroesophageal junction adenocarcinoma. FLOT is now the standard perioperative regimen replacing the MAGIC trial protocol (ECF). Trastuzumab is added for HER2+ disease in the palliative setting (ToGA trial).
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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