Dados do Trabalho

Título

A REAL-WORLD EFFECTIVENESS OF PERIOPERATIVE FLOT REGIMEN IN GASTRIC CANCER

Introdução

Perioperative chemotherapy (chemo) with the FLOT regimen has become one of the most common strategies utilized in non-metastatic gastric cancer (GC). However, there are no prospective comparisons with upfront surgery followed by adjuvant chemo, which could prompt questions regarding consideration as the standard of care.

Objetivo

We aim to evaluate the efficacy of perioperative FLOT in pts with GC treated in public hospitals in Brazil. In addition, we sought to evaluate the impact of baseline clinical, laboratory, and pathological factors on the clinical outcomes.

Método

This multicenter retrospective analysis included patients who underwent FLOT for a non-metastatic GC. Data collection was performed focusing on factors hypothesized to be potentially associated with the outcomes of interest, which are complete or near-complete pathologic response – pCR (ypT0-ypT1 and ypN0), progression before GC resection, and any progression. Parameters included for analysis were weight loss, anemia, hypoalbuminemia, any G3 toxicity on FLOT, any dose reduction, 7-day FLOT deferrals, full FLOT cycles compliance, histological diffuse-type carcinoma, and positive post-operative margins. We evaluated survival through Kaplan Meier and performed the univariate analysis with each parameter of interest and clinical outcomes.

Resultado

Eighty pts included for analysis: 12.8 months of median follow-up since the beginning of neoadjuvant FLOT. Seventy-five pts (93%) completed four cycles of neoadjuvant chemo, and among those who initiated adjuvant FLOT, 31 (73%) completed four cycles of chemo. Twenty-one pts (26%) presented progressive disease before GC resection, 14 of whom had a peritoneal or locally inoperative progression, and 7 had a distant progression. Among pts undergoing surgery, 18 (22%) achieved a pCR. Among factors analyzed, only positive post-operative margins were significantly associated with progression (p=0.028). Upon OS Kaplan Meier's depiction, at a 12-month cut-off follow-up, 35 pts (43%) were still alive. None of the patients with a pCR had a recurrence at the end of the follow-up.

Conclusão

In this retrospective cohort, pts treated in public hospitals using perioperative FLOT regimen have achieved similar clinical outcomes compared to controlled clinical trials. However, a high rate of progressive disease before GC resection was noticed.

Palavras-chave

GASTRIC CANCER, NEOADJUVANT THERAPY, CHEMOTHERAPY