A 60-year-old patient with T3N2M0 gastric adenocarcinoma (signet ring cell type) at the gastroesophageal junction (Siewert Type III) is being considered for surgery. The FLOT4-AIO trial changed gastric cancer perioperative chemotherapy. Which regimen does FLOT4 support as superior to MAGIC (ECF/ECX)?
- A Docetaxel, oxaliplatin, leucovorin, 5-fluorouracil (FLOT) perioperative chemotherapy ✓
- B Cisplatin and capecitabine (XELOX) adjuvant chemotherapy post-surgery
- C Trastuzumab plus chemotherapy for all gastric cancers regardless of HER2 status
- D Nivolumab plus chemotherapy in the neoadjuvant setting for all gastric cancers
Explanation
The FLOT4-AIO phase III trial (Al-Batran et al., Lancet 2019) demonstrated superiority of perioperative FLOT (docetaxel, oxaliplatin, leucovorin, 5-FU — 4 cycles pre- and 4 cycles post-surgery) over the ECF/ECX regimen (MAGIC protocol) for resectable gastric and GEJ adenocarcinoma, with significantly improved median OS (50 vs 35 months) and higher R0 resection rates. FLOT is now the standard perioperative regimen in Europe. Trastuzumab is only for HER2+ metastatic disease (ToGA trial). Nivolumab adjuvant therapy (CheckMate-577) is approved specifically for post-chemoradiotherapy oesophageal/GEJ cancers with residual disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.