The FLOT (Fluorouracil, Leucovorin, Oxaliplatin, Docetaxel) protocol for gastric cancer became a standard perioperative regimen based on the FLOT4 trial. FLOT was compared to which older regimen in this trial?

• A ECF (Epirubicin, Cisplatin, 5-Fluorouracil)
• B ECX (Epirubicin, Cisplatin, Capecitabine)
• C Cisplatin plus S-1 (SPIRITS protocol)
• D EOF/ECF or ECX/EOX (MAGIC-type regimens) ✓

Explanation

The FLOT4-AIO trial (Al-Batran 2019) compared perioperative FLOT with perioperative ECF/ECX/EOF/EOX (the MAGIC-type triplet regimens) in locally advanced resectable gastric/gastroesophageal junction adenocarcinoma. FLOT significantly improved median overall survival (50 vs. 35 months) and pathological complete response rates. FLOT is now the standard of care in Europe and internationally for perioperative chemotherapy in gastric cancer. MAGIC trial (2006) had originally established ECF perioperative chemotherapy as the standard.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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