FLOT Combination Therapy May Be a New Standard for Esophageal Cancer

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The relative effects of FLOT were demonstrable in all subgroups, and was pronounced numerically in patients with Barrett tumors, small tumors T1/2, nodal negative tumors, and Siewert type 1 esophageal
The relative effects of FLOT were demonstrable in all subgroups, and was pronounced numerically in patients with Barrett tumors, small tumors T1/2, nodal negative tumors, and Siewert type 1 esophageal
The following article features coverage from the European Society of Medical Oncology (ESMO) 2017 Congress in Madrid, Spain. Click here to read more of Cancer Therapy Advisor's conference coverage.

Treating patients with resectable esophagogastric cancer with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) may be superior to epirubicin, cisplatin, with fluorouracil or capecitabine (ECF/ECX), according to results from a trial presented at the European Society of Medical Oncology (ESMO) 2017 Congress in Spain.1

In the phase 3 FLOT4 study (ClinicalTrials.gov Identifier: NCT01216644), 716 patients with resectable gastric or gastro-esophageal junction adenocarcinoma of stage cT2 or higher and/or cN+ were randomly assigned to 2 study arms: 3 pre-operative and 3 post-operative 3-week cycles of ECF/ECX or 4 pre-operative and 4 post-operative 2-week cycles of FLOT. The primary outcome of the study was overall survival (OS).

Results from multivariate, subgroup and sensitivity analyses revealed that FLOT was associated with greater overall survival compared to ECF/ECX (50 vs 35 months; hazard ratio [HR], 0.77; P = .012), as well as longer progression-free survival (30 months vs 18 months; HR, 0.75; P = .001).

Patients receiving FLOT also experienced fewer cases of progressive disease during/after preoperative therapy (1% vs 5%; P < .001), greater number of pT0/pT1 tumors (25% vs 15%; P = .001), and more R0-resections (84% vs 77%; P = .011), compared to ECF/ECX.

The relative effects of FLOT were demonstrable in all subgroups, and was pronounced numerically in patients with Barrett tumors, small tumors T1/2, nodal negative tumors, and Siewert type 1 esophageal tumors.

RELATED: Volatile Organic Compounds and Esophageal Cancer: Understanding the Implications for Diagnosis and Treatment

Study authors noted that “Patients derived benefit from FLOT even if they were old (> 70 years), had small tumors, a nodal negative status, or a signet cell component. The presence of one of these factors should no longer be a reason for not considering perioperative therapy in daily practice.”

Read more of Cancer Therapy Advisor's coverage of the European Society of Medical Oncology (ESMO) 2017 Congress by visiting the conference page.

Reference

  1. Al-Batran S, Pauligk C, Homann N, et al. Docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) for resectable esophagogastric cancer: Updated results from multicenter, randomized phase 3 FLOT4-AIO trial (German Gastric Group at AIO).  Presented at: ESMO 2017 Congress; Madrid, Spain: September 8-12, 2017. Abstract LBA27.

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