A 60-year-old man with cT3N2M0 gastric cancer at the gastro-oesophageal junction (Siewert type III) is being planned for resection. Based on the FLOT4-AIO trial (Al-Batran et al., Lancet 2019), which perioperative chemotherapy regimen has shown superior overall survival over ECF/ECX?
- A FLOT (5-FU + leucovorin + oxaliplatin + docetaxel) ✓
- B FOLFOX (oxaliplatin + leucovorin + 5-fluorouracil)
- C ECF (epirubicin + cisplatin + 5-FU)
- D Capecitabine + oxaliplatin (CAPOX)
Explanation
The FLOT4-AIO trial (Lancet 2019) compared FLOT (docetaxel 50 mg/m², oxaliplatin 85 mg/m², leucovorin 200 mg/m², 5-FU 2600 mg/m² per 2-week cycle) versus ECF/ECX as perioperative chemotherapy for resectable gastric and junctional adenocarcinoma. FLOT significantly improved median overall survival (50 vs 35 months), pathological complete response rates (16% vs 6%), and R0 resection rates. FLOT is now the standard perioperative regimen for resectable gastric/GEJ adenocarcinoma, replacing ECF in most international guidelines (ESMO, NCCN). ECF was previously the gold standard from the MAGIC trial.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.