In the FLOT4 trial for locally advanced gastric and GEJ adenocarcinoma, perioperative FLOT chemotherapy was compared to ECF/ECX. The primary finding that changed the standard of care was:
- A FLOT (docetaxel + oxaliplatin + leucovorin + 5-FU) improved median OS from 35 months (ECF/ECX) to 50 months, making it the new perioperative chemotherapy standard ✓
- B FLOT improved 5-year overall survival from 36% (ECF/ECX) to 45% with manageable toxicity
- C FLOT achieved higher pathological complete response rates but equivalent overall survival to ECF/ECX
- D FLOT was equivalent in efficacy but had less toxicity than ECF/ECX
Correct answer: A. FLOT (docetaxel + oxaliplatin + leucovorin + 5-FU) improved median OS from 35 months (ECF/ECX) to 50 months, making it the new perioperative chemotherapy standard
Explanation
The FLOT4 trial demonstrated that perioperative FLOT (docetaxel, oxaliplatin, leucovorin, 5-FU — 4 preoperative and 4 postoperative cycles) improved median overall survival to 50 months compared to 35 months with ECF/ECX, with a 5-year OS of 45% vs 36%. FLOT also achieved a higher pCR rate (15-16% vs 6% for ECF). This established FLOT as the standard perioperative chemotherapy regimen for resectable locally advanced gastric and GEJ cancers. FLOT has more haematological toxicity but is better tolerated than ECF in terms of nausea, alopecia, and renal toxicity.
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.