Neoadjuvant Chemotherapy Followed by Surgery for Metastatic Gastric Cancer

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 (ClinicalTrials.gov 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.

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).

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

Reference

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]