Abstract 196P
Background
The current standard of care for resectable gastric and GEJ cancers is perioperative chemotherapy with FLOT. Although its benefits in improving rates of pathologic complete response, increasing prospects of R0 resection,and improving survival have been proven, efforts to find novel strategies which can improve on its gains continue.The addition of an immune checkpoint inhibitor to FLOT has been a focal point of research in this field. This meta-analysis evaluated high-quality data from clinical trials to determine the efficacy of this chemoimmunotherapycombination.
Methods
A systematic search of English-language articles on PubMed, Cochrane and Google scholar was done to identifyrandomized trials investigating the use of perioperative FLOT and immune checkpoint inhibitors in the treatmentof resectable gastric and GEJ cancer. Quality of studies was assessed using the Revised Cochrane risk-of-bias toolfor randomized trials. Inverse variance was the statistical method used with random effects as the analysis model inthe production of the Forest plot and calculation of odds ratio at 95% CI.
Results
Three RCTs (N = 1446), each with two arms, were included in the meta-analysis. The Phase II Dante Trial (N= 295)compared perioperative FLOT alone with perioperative atezolizumab + FLOT. The Phase III Keynote 585 trial(N=203) and the phase III Matterhorn trial (N=948) compared perioperative placebo + FLOT with perioperativepembrolizumab + FLOT, and perioperative Durvalumab + FLOT, respectively. Risk of bias and heterogeneity were low. Pooled results showed that in patients given perioperative FLOT + immunotherapy, there is statistically significantimprovement in the rate of pathologic complete response (OR 2.60 95% CI 1.88-3.61, p <0.0001). In terms of rateof R0 resection, there was no statistically significant difference between the two groups (OR 1.02 95% CI 0.75-1.38, p= 0.92).
Conclusions
This analysis shows that adding immunotherapy to FLOT improves the rate of pathologic complete response, andmaintains the high rate of R0 resection, in resectable gastric and GEJ cancers. Favorable results of pending survivaloutcomes from these trials may help re-shape the current standard of care in this field.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.