Single institute experience of peri-operative FLOT chemotherapy

Patients with locally advanced gastric or gastroesophageal junction adenocarcinoma (LAGC) usually presents with significant loss of weight and appetite affecting their overall performance status. FLOT regimen (5-Fluorouracil, Docetaxel and oxaliplatin) has a proven role in perioperative management of these cancers, however it has its own share of toxicities. In this retrospective single centre study we evaluate the compliance and efficacy of this regime in unselected non trial patients with adequate performance status (PS), who underwent multi-modality treatment for LAGC with perioperative FLOT chemotherapy and surgery.

Between March 2018 and January 2022, 58 patients were diagnosed with LAGC (histologically confirmed) and planned for perioperative treatment with FLOT. Baseline performance status required for consideration of this treatment was ECOG PS 0 or 1. Patient demographics, compliance with chemotherapy, response assessment on pathological specimen and progression free survival was analysed. Prophylactic GCSF (Granulocyte Colony Stimulating Factor) was used in all patients.

58 Patients diagnosed with LAGC were included in this study. The mean age of patients was 60.2years (Range 36-77 years) and were predominantly males (85%). 91% (53/58) completed all 4 pre-operative chemotherapy with only 72% (42/58) patient receiving standard dose. 58% (34/58) patients started post-operative chemotherapy and 40% (23/58) were able to complete all 8 cycles of FLOT. 86% (50/58) patients underwent surgery after pre-operative treatment and 2 found to have disease progression intra-operatively. 83% patients (40/48) had R0 resection. Mandard classification is used at our centre for evaluation of tumour regression grading after neo-adjuvant chemotherapy. 60.4% (29/48) patients were found to have TRG 4/5. Patients who didn’t have surgery underwent either palliative or consolidation RT with or without concurrent chemotherapy. 14/48 patients who underwent surgery and in total 22 patients developed recurrence. Mean Disease free survival for all the patients was 19.7months as compared to 21 months who underwent surgery and 12.4 months who didn’t. Until February 2023, 20 patient have passed away either due to recurrence or surgical complications.

As seen in the reference trial FLOT4, our study population has mean age of 60years with majority of males. Similarly 91% patient were able to complete preoperative treatment though nearly 28% had to have dose reduction either due to performance status or toxicities. Use of prophylactic GCSF prevented neutropenia in all but 1 patient. Again, 58% of initial population were allocated to have adjuvant chemotherapy, only 40% were able to complete all the cycles. And half of those who completed all 8 cycles (12/58) did with standard dose. Rate of R0 resection remain very similar to the original trial, however the pathological tumour regression to neo-adjuvant chemotherapy showed poor response as nearly 60% had TRG 4/5.

The authors.

Has not received any funding.

All authors have declared no conflicts of interest.