A 55-year-old man with gastric cancer (cT3N1M0, intestinal type, antrum) is planned for curative resection. According to the FLOT4 trial, which perioperative chemotherapy regimen has been shown to improve overall survival compared to ECF/ECX?
- A ECF (epirubicin, cisplatin, 5-FU) — 3 cycles pre + 3 cycles post surgery (MAGIC regimen)
- B FOLFOX alone as adjuvant chemotherapy after D2 resection
- C FLOT (5-fluorouracil, leucovorin, oxaliplatin, docetaxel) — 4 cycles pre + 4 cycles post surgery ✓
- D Trastuzumab-based therapy regardless of HER2 status
Correct answer: C. FLOT (5-fluorouracil, leucovorin, oxaliplatin, docetaxel) — 4 cycles pre + 4 cycles post surgery
Explanation
The FLOT4 trial (Al-Batran et al., NEJM 2019) demonstrated that perioperative FLOT (5-FU, leucovorin, oxaliplatin, docetaxel — 4 pre-operative + 4 post-operative cycles) significantly improved median overall survival compared to ECF/ECX (50 months vs 35 months) in resectable gastric and GEJ adenocarcinoma. FLOT has replaced ECF/ECX as the preferred perioperative chemotherapy regimen. Trastuzumab is added only for HER2-positive tumors (ToGA trial). The MAGIC trial established perioperative ECF; FLOT has now superseded it.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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