Clinical Study

Total neoadjuvant chemotherapy with FLOT scheme in resectable adenocarcinoma of the gastro-oesophageal junction or gastric adenocarcinoma: impact on pathological complete response and safety

13 Jan 2021
Luis Villanueva, Jaime Anabalón, Jean M Butte, Pamela Salman, Sergio Panay, Elizabeth Milla, Carlos Gallardo, Sebastian Hoefler, Roberto Charles, Felipe Reyes, Olga Barajas, Luis Matamala, Angelica Molina, Sergio Portiño, Marcela Berrios, Christian Caglevic, Mauricio Mahave

Background: Gastric cancer is the fifth cause of cancer incidence worldwide. Multidisciplinary approaches that improve the survival are needed. Perioperative chemotherapies show improvement in pathological complete remission (pCR) and overall survival (OS), but less than 50% of the patients completed the chemotherapeutic regimen. The recent 5-fluorouracil, leucovorin, oxaliplatin, docetaxel-4 (FLOT4) study shows OS 50 months and pCR 16.6%, but only 46% of the patients completed pre- and postoperative treatment. This case series report evaluated pCR and safety in patients that received complete preoperative chemotherapeutic with FLOT.

Methods: Patients received eight cycles FLOT regimen before surgery. Each cycle comprised 50 mg/m2 docetaxel intravenous (iv) on day 1, 85 mg/m2 oxaliplatin iv on day 1, 200 mg/m2 leucovorin iv on day 1 and 2,600 mg/m2 5-fluorouracil iv in a 24-hour infusion on day 1, every 2 weeks.

Results: Fifty-nine patients were evaluated, 58 patients received preoperative cycles. Thirty-one patients received all eight cycles of preoperative therapy. 65.5% patients presented any major adverse event. Thirty-nine patients underwent surgery. Thirty-three biopsy reports were obtained. Six patients (18.2%) presented pCR, 13 patients (39.4%) had no lymph node involvement. OS was 21.32 months. Patients with histology of signet ring carcinoma cells had a shorter survival than other histologies.

Conclusion: Total neoadjuvant with FLOT chemotherapy presents an adequate safety profile, a similar pathologic regression rate, and a slightly higher rate of completing treatment to report in perioperative FLOT regimen studies. A prospective clinical study with suitable diagnostic, staging tools and an adequate follow-up may prove total neoadjuvant chemotherapy’s efficacy.

Related Articles

Hemanth Raj, Marri Sri Santosh Keerthi, Ravisankar Palaniappan, Ujwala Prakash, Manikandan Dhanushkodi, Trivadi S Ganesan
Severyn Ferneza, Markiyan Fetsych, Roman Shuliak, Halyna Makukh, Natalia Volodko, Roman Yarema, Tara Fetsych
Eduardo Payet, Joan Perez, Gustavo Sarria, Silvia Neciosup, Francisco Berrospi, Sheila Vilchez, Jorge Dunstan, Ronald Perez, Mauricio Vassallo, Santiago Salgado, Nanto Caparachín, Joseph A Pinto, Alexis Holguin
Bettina Müller, Carlos García, José A Sola, Wanda Fernandez, Patrick Werner, Mauricio Cerda, Jeannie Slater, Carlos Benavides, Jorge Arancibia, Rodrigo Ascui, Felipe Reyes, Mary Anne Stevens, Juan Pablo Miranda, Martin Buchholtz, Alejandro Corvalan
Chandrayee Sarker, Vivek S Radhakrishnan, Paya Mandal, Jeevan Kumar, Saurabh Bhave, Rimpa Achari, Debdeep Dey, Indu Arun, Zameer Latif, Neeraj Arora, Deepak Mishra, Mammen Chandy, Reena Nair