A patient with gastric adenocarcinoma at the cardia (Siewert type II) undergoes total gastrectomy. According to the FLOT4-AIO trial, which perioperative chemotherapy regimen showed superior overall survival compared to ECF/ECX regimen?
- A FOLFOX (folinic acid, 5-FU, oxaliplatin)
- B Cisplatin + capecitabine (XELOX) given pre-operatively only
- C FLOT (5-FU, leucovorin, oxaliplatin, docetaxel) given 4 cycles pre-operative and 4 cycles post-operative ✓
- D Docetaxel + cisplatin + 5-FU (DCF) given post-operatively only
Explanation
The FLOT4-AIO trial (Al-Batran et al., Lancet 2019) compared perioperative FLOT (5-FU/leucovorin + oxaliplatin + docetaxel, 4 cycles pre-op + 4 cycles post-op) with perioperative ECF/ECX (epirubicin + cisplatin + 5-FU or capecitabine) for resectable gastric and GEJ adenocarcinoma. FLOT demonstrated superior median overall survival (50 vs 35 months), 5-year OS (45% vs 36%), and pathological complete response rates (16% vs 6%) with manageable toxicity. FLOT has replaced ECF/ECX as the standard perioperative regimen for gastric and GEJ adenocarcinoma in Europe (MAGIC-based approach) and is now adopted in international guidelines including ESMO.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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