Neoadjuvant chemotherapy followed by surgery improves survival among patients with metastatic gastric and gastroesophageal junction cancer, according to a study published in JAMA Oncology.1

Patients with gastric cancer have poor survival due to the disease often being detected only at later stages. For the non-randomized, phase 2 AIO-FLOT3 study ( Identifier: NCT00849615), researchers attempted to determine whether pre-surgical fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) would improve outcomes in this patient population.

Two hundred and thirty-eight patients were assigned to 1 of 3 treatment arms: Arm A, for patients without distant metastatic disease; Arm B, for patients with metastatic disease meeting pre-defined criteria; Arm C, for patients with metastatic disease not meeting the criteria for Arm B. One major criterion for inclusion in Arm B was metastatic disease only to the abdomen or retroperitoneal lymph nodes.

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Patients in Arm A received FLOT followed by surgery followed by FLOT. Patients in Arms B and C received FLOT followed by surgery only if the cancer was deemed operable post-chemotherapy.

Median overall survival was not achieved in Arm A. Median overall survival was 22.9 months in Arm B and 10.7 months in Arm C. Ten percent of patients in Arm B had a complete response.

Patients who proceeded to surgery had a median overall survival nearly double of that for patients not treated surgically (31.3 months vs 15.9 months).

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The authors concluded that neoadjuvant FLOT followed by surgery improves outcomes among patients with gastric or gastroesophageal junction cancer.


  1. Al-Batran SE, Homann N, Pauligk C, et al. Effect of neoadjuvant chemotherapy followed by surgical resection on survival in patients with limited metastatic gastric or gastroesophageal junction cancer: the AIO-FLOT3 trial. JAMA Oncol. 2017 Apr 27. doi: 10.1001/jamaoncol.2017.0515 [Epub ahead of print]