The importance of the perioperative chemotherapy regimen (fluorouracil, leucovorin, oxaliplatin, and docetaxel) in the treatment of locally advanced gastric cancer

Keywords

FLOT - gastric cancer - toxicity - neoadjuvant chemotherapy

Introduction: Gastric cancer is one of the most frequent neoplasms in both genders, not only in the Brazilian population but also worldwide, and it is one of the most lethal cancer types. Given the high mortality rate in 5 years, about 31% for locally advanced tumors, new and more effective therapeutic strategies are urgently needed. In this context, the perioperative chemotherapy regimen FLOT (Fluorouracil, Leucovorin, Oxaliplatin, and Docetaxel) has been adopted in various institutions and proven clinically relevant.

Objective: To evaluate the clinical behavior and therapeutic response of the FLOT regimen in patients treated at a public healthcare service.

Methods: A total of 35 patients with locally advanced gastric adenocarcinoma who underwent neoadjuvant treatment (NAT) with the FLOT regimen, followed by surgery and subsequent adjuvant treatment (AT), were evaluated from January 2018 to December 2023. Parameters such as staging, adverse events, surgical resection, tumor response to neoadjuvant therapy, and the number of chemotherapy cycles administered were analyzed.

Results: Of the 35 patients (23M, 12F; median age 62y), 23 completed the 4 NAT cycles, 1 completed 6 NAT cycles, but only 7 completed the full regimen (4 NAT+4 AT). A total of 29 patients received surgery with the majority receiving a total gastrectomy. From these, 24 cases underwent R0 resection. Of the 21 patients with available surgical specimen histopathology, 19.1% had a complete response to NAT, and an additional 61.8% had a partial or stable pathologic response. Among the 149 cycles analyzed in total, the most common severe adverse events (grade 3 or higher) were hematological, including 16 cases of neutropenia (10.74%), 2 cases of grade 3 anemia, and 1 case of febrile neutropenia. Other notable adverse events included grade 2 diarrhea (10.74%) and grade 3 (4%), and grade 2 nausea (2.68%) and grade 3 (1.34%) of the cycles. The median follow-up time was 27.3 months. Of the 35 patients, 51% are known to be alive, 32% have died, and 17% were lost to follow-up.

Conclusion: The retrospective study confirmed the efficacy of the FLOT regimen for locally advanced gastric cancer, with relatively well-tolerable patient feedback despite the conditions of a public healthcare setting and the predominantly advanced initial staging. The tumor response to NAT was comparable to previously conducted studies. In some cases, dose adjustments were necessary due to observed toxicity.

Corresponding author: Luana Rozette Pires (e-mail: [e-mail]).

 

Scroll to top

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
06 May 2025