Perioperative Chemotherapy for Gastro-Esophageal or Gastric Cancer: Anthracyclin Triplets versus FLOT
<i>Background:</i> The FLOT4-AIO trial (2019) showed improved survival with perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) compared to anthracyclin triplets in gastric cancer treatment. It is unclear whether these results extend to real-world scenarios in the N...
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| Format: | Article |
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MDPI AG
2024-03-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/16/7/1291 |
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| author | Julie F. M. Geerts Charlène J. van der Zijden Pieter C. van der Sluis Manon C. W. Spaander Grard A. P. Nieuwenhuijzen Camiel Rosman Hanneke W. M. van Laarhoven Rob H. A. Verhoeven Bas P. L. Wijnhoven Sjoerd M. Lagarde Bianca Mostert |
| author_facet | Julie F. M. Geerts Charlène J. van der Zijden Pieter C. van der Sluis Manon C. W. Spaander Grard A. P. Nieuwenhuijzen Camiel Rosman Hanneke W. M. van Laarhoven Rob H. A. Verhoeven Bas P. L. Wijnhoven Sjoerd M. Lagarde Bianca Mostert |
| author_sort | Julie F. M. Geerts |
| collection | DOAJ |
| description | <i>Background:</i> The FLOT4-AIO trial (2019) showed improved survival with perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) compared to anthracyclin triplets in gastric cancer treatment. It is unclear whether these results extend to real-world scenarios in the Netherlands. This study aimed to compare outcomes of perioperative FLOT to anthracyclin triplets in a real-world Dutch gastric cancer population. <i>Methods:</i> Patients diagnosed with resectable (cT2-4a/cTxN0-3/NxM0) gastric or gastro-esophageal junction carcinoma between 2015–2021 who received neoadjuvant FLOT or anthracyclin triplets were selected from the Netherlands Cancer Registry. The primary outcome was overall survival (OS), analyzed through multivariable Cox regression. Secondary outcomes included pathological complete response (pCR), neoadjuvant chemotherapy cycle completion, surgical resection rates, and adjuvant therapy. <i>Results:</i> Adjusted OS showed no significant survival benefit (HR = 0.88, 95% CI 0.77–1.01, <i>p</i> = 0.07), even though the median OS was numerically improved by 8 months with FLOT compared to anthracyclin triplets (48.1 vs. 39.9 months, <i>p</i> = 0.16). FLOT patients were more likely to undergo diagnostic staging laparoscopies (74.2% vs. 44.1%, <i>p</i> < 0.001), had higher rates of completing neoadjuvant chemotherapy (OR = 1.35, 95% CI 1.09–1.68, <i>p</i> = 0.007), receiving adjuvant therapy (OR = 1.34, 95% CI 1.08–1.66, <i>p</i> = 0.08), and achieving pCR (OR = 1.52, 95% CI 1.05–2.20, <i>p</i> = 0.03). No significant differences were observed in (radical) resection rates. <i>Conclusion(s):</i> Real-world data showed no significant OS improvement for FLOT-treated patients compared to anthracyclin triplets, despite more staging laparoscopies. However, FLOT patients demonstrated higher rates of neoadjuvant therapy completion, proceeding to adjuvant therapy, and increased pCR rates. Therefore, we recommend the continued use of neoadjuvant FLOT therapy in the current clinical setting. |
| first_indexed | 2024-04-24T10:49:03Z |
| format | Article |
| id | doaj.art-88dbe768560e4df89515f0f51a4e21d3 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-04-24T10:49:03Z |
| publishDate | 2024-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-88dbe768560e4df89515f0f51a4e21d32024-04-12T13:15:56ZengMDPI AGCancers2072-66942024-03-01167129110.3390/cancers16071291Perioperative Chemotherapy for Gastro-Esophageal or Gastric Cancer: Anthracyclin Triplets versus FLOTJulie F. M. Geerts0Charlène J. van der Zijden1Pieter C. van der Sluis2Manon C. W. Spaander3Grard A. P. Nieuwenhuijzen4Camiel Rosman5Hanneke W. M. van Laarhoven6Rob H. A. Verhoeven7Bas P. L. Wijnhoven8Sjoerd M. Lagarde9Bianca Mostert10Department of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The NetherlandsDepartment of Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The NetherlandsDepartment of Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The NetherlandsDepartment of Gastroenterology and Hepatology, Erasmus University Medical Center, 3015 GD Rotterdam, The NetherlandsDepartment of Surgery, Catharina Hospital, 5623 EJ Eindhoven, The NetherlandsDepartment of Surgery, Radboud University Medical Center, 6525 GA Nijmegen, The NetherlandsDepartment of Medical Oncology, Amsterdam UMC Location University of Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Medical Oncology, Amsterdam UMC Location University of Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The NetherlandsDepartment of Surgery, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The NetherlandsDepartment of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands<i>Background:</i> The FLOT4-AIO trial (2019) showed improved survival with perioperative fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) compared to anthracyclin triplets in gastric cancer treatment. It is unclear whether these results extend to real-world scenarios in the Netherlands. This study aimed to compare outcomes of perioperative FLOT to anthracyclin triplets in a real-world Dutch gastric cancer population. <i>Methods:</i> Patients diagnosed with resectable (cT2-4a/cTxN0-3/NxM0) gastric or gastro-esophageal junction carcinoma between 2015–2021 who received neoadjuvant FLOT or anthracyclin triplets were selected from the Netherlands Cancer Registry. The primary outcome was overall survival (OS), analyzed through multivariable Cox regression. Secondary outcomes included pathological complete response (pCR), neoadjuvant chemotherapy cycle completion, surgical resection rates, and adjuvant therapy. <i>Results:</i> Adjusted OS showed no significant survival benefit (HR = 0.88, 95% CI 0.77–1.01, <i>p</i> = 0.07), even though the median OS was numerically improved by 8 months with FLOT compared to anthracyclin triplets (48.1 vs. 39.9 months, <i>p</i> = 0.16). FLOT patients were more likely to undergo diagnostic staging laparoscopies (74.2% vs. 44.1%, <i>p</i> < 0.001), had higher rates of completing neoadjuvant chemotherapy (OR = 1.35, 95% CI 1.09–1.68, <i>p</i> = 0.007), receiving adjuvant therapy (OR = 1.34, 95% CI 1.08–1.66, <i>p</i> = 0.08), and achieving pCR (OR = 1.52, 95% CI 1.05–2.20, <i>p</i> = 0.03). No significant differences were observed in (radical) resection rates. <i>Conclusion(s):</i> Real-world data showed no significant OS improvement for FLOT-treated patients compared to anthracyclin triplets, despite more staging laparoscopies. However, FLOT patients demonstrated higher rates of neoadjuvant therapy completion, proceeding to adjuvant therapy, and increased pCR rates. Therefore, we recommend the continued use of neoadjuvant FLOT therapy in the current clinical setting.https://www.mdpi.com/2072-6694/16/7/1291esophageal cancergastro-esophageal cancergastric cancerneoadjuvant chemotherapyesophagectomy |
| spellingShingle | Julie F. M. Geerts Charlène J. van der Zijden Pieter C. van der Sluis Manon C. W. Spaander Grard A. P. Nieuwenhuijzen Camiel Rosman Hanneke W. M. van Laarhoven Rob H. A. Verhoeven Bas P. L. Wijnhoven Sjoerd M. Lagarde Bianca Mostert Perioperative Chemotherapy for Gastro-Esophageal or Gastric Cancer: Anthracyclin Triplets versus FLOT Cancers esophageal cancer gastro-esophageal cancer gastric cancer neoadjuvant chemotherapy esophagectomy |
| title | Perioperative Chemotherapy for Gastro-Esophageal or Gastric Cancer: Anthracyclin Triplets versus FLOT |
| title_full | Perioperative Chemotherapy for Gastro-Esophageal or Gastric Cancer: Anthracyclin Triplets versus FLOT |
| title_fullStr | Perioperative Chemotherapy for Gastro-Esophageal or Gastric Cancer: Anthracyclin Triplets versus FLOT |
| title_full_unstemmed | Perioperative Chemotherapy for Gastro-Esophageal or Gastric Cancer: Anthracyclin Triplets versus FLOT |
| title_short | Perioperative Chemotherapy for Gastro-Esophageal or Gastric Cancer: Anthracyclin Triplets versus FLOT |
| title_sort | perioperative chemotherapy for gastro esophageal or gastric cancer anthracyclin triplets versus flot |
| topic | esophageal cancer gastro-esophageal cancer gastric cancer neoadjuvant chemotherapy esophagectomy |
| url | https://www.mdpi.com/2072-6694/16/7/1291 |
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