A 65-year-old man is found to have a gastric carcinoma of the antrum. EUS staging shows T3 N2 M0. CT shows no distant metastasis. The FLOT (fluorouracil, leucovorin, oxaliplatin, docetaxel) regimen is planned. According to the FLOT4-AIO trial, the use of perioperative FLOT compared to ECF/ECX demonstrated:
- A Equivalent overall survival but fewer side effects
- B Superior pathological complete response rate and improved overall survival ✓
- C Benefit only in intestinal-type gastric cancers
- D No difference in pCR rate but improved recurrence-free survival only
Correct answer: B. Superior pathological complete response rate and improved overall survival
Explanation
The FLOT4-AIO phase III trial (Al-Batran et al., NEJM 2019) demonstrated that perioperative FLOT significantly improved median overall survival (50 vs 35 months), progression-free survival, and pathological complete response (pCR: 16% vs 6%) compared to ECF/ECX in resectable gastric/GEJ adenocarcinoma. FLOT has therefore replaced ECF/ECX as the perioperative standard of care in Europe. Benefit was seen across histological subtypes.
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.