Perioperative Therapy with Flot4 Significantly Increases Survival in Patients with Gastroesophageal and Gastric Cancer in A Large Real-World Cohort
Menée en Allemagne à l'aide de données 2010-2022 portant sur 99 patients atteints d'un cancer gastro-oesophagien ou gastrique de stade localement avancé, cette étude évalue la faisabilité, la toxicité et l'efficacité, du point de vue de la survie globale médiane, d'un protocole FLOT4 (5-FU, leucovorine, oxaliplatine et docétaxel) par rapport à une chimiothérapie à base de 5-FU et de platine
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 this 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=0.036). Moreover, pathological tumor regression (pTR) was significantly higher in the FLOT group compared to the 5-FU/platinum group (p=0.001). Subgroup analysis showed a favorable survival benefit for the FLOT vs. 5-FU/platinum derivate in patients with AEG and non-signet cell carcinoma. Overall, FLOT was tolerated well but CTCAE ≥3 grade neutropenia and diarrhea occurred more often within the FLOT group. Similar to the prospective phase II/III trials, FLOT4 was the best protocol for patients with locally advanced gastroesophageal and gastric cancer as perioperative therapy in terms of overall survival and pathological response rate compared to 5-FU/platinum derivative protocols. Interestingly, patients with gastroesophageal cancer benefitted more from this therapy. In contrast, patients with signet ring cells appear not to benefit from addition of docetaxel.