Efficacy and tolerability of fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) in unselected patients with advanced gastric and gastroesophageal cancer: does age really matter?

Möhring, Christian; Timotheou, Aliki; Mańczak, Adrianna; Sadeghlar, Farsaneh; Zhou, Taotao; Mahn, Robert; Bartels, Alexandra; Monin, Malte B; Toma, Marieta; Feldmann, Georg; Brossart, Peter; Köksal, Mümtaz; Giordano, Frank A.; Lingohr, Philipp; Jafari, Ahmad; Kalff, Jörg C.; Strassburg, Christian P.; Gonzalez‐Carmona, Maria A.

doi:10.1007/s00432-022-04109-8

Cited by 3 publications

(3 citation statements)

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“…However, adding further drugs [e.g., docetaxel, cisplatin and 5-fluorouracil (DCF), modified DCF, folinic acid, fluorouracil, oxaliplatin, and docetaxel (FLOT)] is not recommended for metastatic disease. E.g., no survival benefit for FLOT over FOLFOX in patients over 65 years was documented, although a recent study reported that PS shows a stronger prognostic value than patient age in FLOT used as first-line therapy in a real-life cohort with advanced and mGC ( 8 , 9 ). The role of a three-drug regimen over platinum-derived and fluoropyrimidine doublets was evaluated in a prospective randomized study which compared the combination of docetaxel, fluorouracil and cisplatin versus cisplatin and fluoropyrimidine.…”

Section: Treatment Landscapementioning

confidence: 99%

The evolving strategies for the management of patients with metastatic gastric cancer: A narrative review and expert opinion

Cascinu

Bartolomeo²,

Beretta³

et al. 2022

Front. Med.

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Gastric cancer (GC) is recognized as one of the most common deadly malignancies worldwide and about 40–50% of patients present at diagnosis with an unresectable disease due to a locally advanced or already metastatic condition. Recently, therapeutic options for management of metastatic GC (mGC) have been approved allowing a potential improvement of patient cancer treatment response and also an establishment of a continuum of care for this aggressive disease. This report is the result of a literature review by an expert panel. The aim of this document is to provide evidence, wherever it is lacking, to provide expert opinion directed at strategic management of mGC, and in particular aspect at practical management where appropriate guidelines are not available. Treatment landscape with new therapeutic strategies for third line and beyond, role of imaging, prognostic factors, symptoms, and markers as well as the importance of multidisciplinary approach particularly the nutritional aspects are discussed.

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Section: Treatment Landscapementioning

confidence: 99%

The evolving strategies for the management of patients with metastatic gastric cancer: A narrative review and expert opinion

Cascinu

Bartolomeo²,

Beretta³

et al. 2022

Front. Med.

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“…7,10 The FLOT regimen, consisting of triple chemotherapy with 5-fluorouracil/leucovorin, oxaliplatin and docetaxel, showed efficacy in several initial studies, both in curative and palliative settings in patients with AEG and GC. [11][12][13] However, it was only after publication of the phase II/III FLOT4 trial findings that the FLOT4 protocol was established as the new perioperative therapy standard for patients with locally advanced adenocarcinomas of AEG and GC. The trial showed a significantly improved OS in the perioperative FLOT group with a median OS of 50 months compared to a median OS of 35 months in the perioperative ECF/ECX group (HR 0.77; 0.63 to 0.94; P = .012).…”

Section: Introductionmentioning

confidence: 99%

“…The FLOT regimen, consisting of triple chemotherapy with 5‐fluorouracil/leucovorin, oxaliplatin and docetaxel, showed efficacy in several initial studies, both in curative and palliative settings in patients with AEG and GC 11‐13 . However, it was only after publication of the phase II/III FLOT4 trial findings that the FLOT4 protocol was established as the new perioperative therapy standard for patients with locally advanced adenocarcinomas of AEG and GC.…”

Section: Introductionmentioning

confidence: 99%

Perioperative therapy with FLOT4 significantly increases survival in patients with gastroesophageal and gastric cancer in a large real‐world cohort

Möhring

Mańczak

Timotheou

et al. 2023

Intl Journal of Cancer

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In 2019, the FLOT4 protocol was established as the new standard for perioperative therapy in patients with locally advanced gastroesophageal and gastric cancer.Whether this protocol is beneficial in a real-world setting remains a question with limited answers to date. In our study, a large cohort of unselected patients treated with FLOT4 was analyzed and compared to protocols based on 5-FU/platinum derivative. This retrospective analysis included patients with locally advanced gastroesophageal and gastric cancer treated with perioperative FLOT or 5-FU/platinum derivative at University Hospital, Bonn between 2010 and 2022 in a curative setting (n = 99).Overall survival, disease-free survival, therapy response and therapy complications were analyzed. Patients treated with FLOT showed a statistically significant longer median overall survival of 57.8 vs 28.9 months (HR: 0.554, 95% CI: 0.317-0.969, P = .036). Moreover, pathological tumor regression (pTR) was significantly higher in the FLOT group compared to the 5-FU/platinum group (P = .001).

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Eficacia y tolerancia del tratamiento perioperatorio con esquema FLOT en pacientes con adenocarcinoma gástrico y la de unión gastroesofágica, tratados en el Hospital Italiano de buenos aires

Aymar,

Basbus,

Gornatti

et al. 2023

RevOnco

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Introducción: El cáncer gástrico y de la unión gastroesofágica (UGE) componen una enfermedad con alta tasa de mortalidad, aun en estadios tempranos. La combinación de cirugía con tratamiento sistémico perioperatorio con esquema FLOT, basado en fluoropirimidinas, oxaliplatino y docetaxel, se ha convertido en el estándar de cuidado para pacientes con adenocarcinomas de la UGE y estómago resecables. El objetivo del presente estudio fue evaluar la eficacia y seguridad de FLOT perioperatorio en pacientes con cáncer gástrico y UGE no metastásico en un hospital de Argentina. Métodos: Estudio retrospectivo observacional llevado a cabo en el Hospital Italiano de Buenos Aires. Se incluyeron pacientes con diagnóstico de adenocarcinoma gástrico y UGE resecables que recibieron FLOT como terapia perioperatoria entre 2018 y 2022. Resultados: Se incluyeron un total de 34 pacientes. La edad mediana al diagnóstico fue 59 años (RIC 52-69). Once pacientes (32%) tuvieron patrón de células en anillo de sello y 7 (21%) sobreexpresaban HER2. Se constató una tasa de respuesta objetiva (ORR) por imágenes de 82% en pacientes que realizaron terapia neoadyuvante. El 30% de los pacientes no completó los 8 ciclos de FLOT planificados, 5 (15%) no realizaron adyuvancia y 4 (12%) no procedieron con la cirugía por progresión. La respuesta patológica completa (pCR) fue de 12.5% (4 pacientes). El 55% de los pacientes tuvieron demora en al menos un ciclo de tratamiento por toxicidad hematológica. Un paciente murió por neutropenia febril. Con una mediana de seguimiento de 25 meses, 20 pacientes (59%) recayeron, con una mediana de tiempo a la recaída de 16 meses. Durante el seguimiento, 12 pacientes murieron, la mediana de sobrevida no fue alcanzada. Conclusiones: El régimen perioperatorio FLOT tuvo mayor toxicidad y fue menos tolerado que lo reportado en otras series. Esto se tradujo en resultados clínicos desfavorables en nuestra cohorte. Este estudio de real-world demostró la baja compliance de regímenes de poliquimioterapia en pacientes con cáncer gástrico temprano y respaldan la necesidad de futuras investigaciones para mejorar los resultados en esta población de pacientes.

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Efficacy and tolerability of fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) in unselected patients with advanced gastric and gastroesophageal cancer: does age really matter?

Cited by 3 publications

References 36 publications

The evolving strategies for the management of patients with metastatic gastric cancer: A narrative review and expert opinion

The evolving strategies for the management of patients with metastatic gastric cancer: A narrative review and expert opinion

Perioperative therapy with FLOT4 significantly increases survival in patients with gastroesophageal and gastric cancer in a large real‐world cohort

Eficacia y tolerancia del tratamiento perioperatorio con esquema FLOT en pacientes con adenocarcinoma gástrico y la de unión gastroesofágica, tratados en el Hospital Italiano de buenos aires

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