The FLOT4 trial compared perioperative FLOT (docetaxel, oxaliplatin, leucovorin, 5-FU) versus perioperative ECF/ECX (epirubicin, cisplatin, 5-FU/capecitabine) for resectable gastric and gastro-oesophageal junction adenocarcinoma. The primary outcome showed FLOT had:
- A Superior overall survival (median 50 vs 35 months) and higher pCR rate ✓
- B Inferior overall survival due to greater haematological toxicity
- C Equivalent overall survival but higher R0 resection rate
- D Benefit only in HER2-positive gastric cancer patients
Correct answer: A. Superior overall survival (median 50 vs 35 months) and higher pCR rate
Explanation
The FLOT4 trial (Al-Batran et al., NEJM 2019) showed perioperative FLOT significantly improved median overall survival (50 vs 35 months, HR 0.77) and pathological complete response rate (16% vs 6%) versus ECF/ECX. FLOT is now the standard perioperative chemotherapy regimen for resectable gastric and GOJ adenocarcinoma in fit patients, replacing the MAGIC trial's ECF/ECX regimen. HER2 status does not select FLOT benefit; trastuzumab is added in HER2-positive metastatic disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.