5908 - Perioperative chemotherapy with Docetaxel, Oxaliplatin, Fluorouracil and Leucovorin (FLOT) versus Epirubicin, Platinum and Capecitabine or Flourouracil (EOX/ECF) in Resectable Gastric or Gastroesophageal Junction Adenocarcinoma- Safety and response data from India.

Background

Gastric and GEJ cancers are one of the top four cancers in India with poor 5-year survival. Post ASCO 2017, we switched to docetaxel-based peri-operative chemotherapy (FLOT) which is the new standard of care. In this audit, we report the pathological response and toxicity of FLOT compared to our older standard (EOX/ECF).

Methods

We analysed our database of 118 patients with gastric or GEJ adenocarcinoma treated at our center from May 2011 to April 2019. 85 patients (72%) received perioperative chemotherapy with three pre-operative and three post-operative 3-week cycles of either EOX (50mg/m2 Epirubicin and 130mg/m2 Oxaliplatin on Day 1 plus 1250mg/m2 Capecitabine for 21 days) or ECF (50mg/m2 Epirubicin and 60mg/m2 Cisplatin on Day 1 plus 800mg/m2/day Fluorouracil as continuous intravenous infusion for 5 days). 33 patients (28%) received four pre-operative and four post-operative 2-week cycles of intravenous FLOT (50mg/m2 Docetaxel, 85mg/m2 Oxaliplatin, 200mg/m2 Leucovorin and 2600mg/m2 Fluorouracil as 24hr infusion on Day 1). We compared the toxicity, and pathological tumor response rates of patients on EOX/ECF and FLOT regimens.

Results

The patients were aged 30 to 73 years (Median 58 years) and 40 (34%) were women. 85 patients received either EOX/ECF and 33 received FLOT chemotherapy. 64 (75%) patients in EOX/ECF underwent gastrectomy among whom eight (12.5%) had pathological Tumour Regression Score (TRS) of 0 or 1. 24 (72%) patients in FLOT group have undergone gastrectomy of whom six (25%) had TRS of 0 or 1. 34 (40%) patients completed full EOX/ECF regimen while 20 (60%) completed full FLOT. The commonest reason for not completing the peri-operative chemotherapy was toxicity in EOX/ECF group (29%) and refusal to undergo surgery (21%) in the FLOT group. 15% patients did not complete FLOT chemotherapy due to toxicity.

Conclusions

FLOT regimen is a better tolerated perioperative therapy in Indian patients achieving higher pathological response compared to EOX/ECF regimen. The patients in both groups are currently on follow up to capture the relapse free survival duration.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Tanuj Chawla.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.