Abstract 1389P
Background
In locally advanced gastroesophageal and gastric cancers, which constitute the majority of the presentation, the postoperative 5 year survival rate remains only 30-40%. It is in these patients that perioperative chemotherapy has helped improve radical resection rates control preoperative micrometastases and improve survival. Since 2017,FLOT based chemotherapy has largely replaced ECF/ECX in this setting. We did a retrospective analysis on our patients treated with FLOT regimen during the COVID-19 pandemic to assess its efficacy, tolerance and pathological response (TRG).
Methods
Patients with resectable gastric and GOJ cancers who presented to us from August 2019 – March 2020 and treated with FLOT based perioperative chemotherapy were analyzed with SPSS (version 26, IBM, Armonk, NY). Pathologic assessment of tumour regression was done by Mandard's TRG scoring. A total of 36 patients were analysed, out of which 91% were males, median age 68 years,cT3/T4 86%, cN1/2 72.2%,GOJ 77.8%,Gastric 22%,Grade 2/3 94%.Total of 80.6% patients completed all 4 cycles of neoadjuvant FLOT and 88.9% patients underwent surgery(all R0).Median interval between last dose of chemo and surgery was 7 weeks.A total of 52.8% patients completed all 4 cycles of adjuvant FLOT. Treatment was delayed due to COVID-19 in 11%.
Results
Median followup was 16.3 mths.1 year DFS was 66.3% and OS was 91.4%.Pathological CR(TRG 1) was seen in 2.8% patients.3 patients died due to postop complications. Most common grd-3 toxicities were oral mucositis(6%), diarrhea (6%),neutropenia(8.3%).5FU cardiotoxicity noted in 5.6%. Table: 1389P
| TRG (Mandard) | Frequency | Percent |
| 1(complete regression) | 1 | 2.8 |
| 2(rare residual cancer cells) | 4 | 11.1 |
| 3(increased no. of cancer cells,fibrosis still predominates) | 13 | 36.1 |
| 4(residual cancer outgrowing fibrosis) | 10 | 27.8 |
| 5(absence of regressive changes) | 4 | 11.1 |
Conclusions
In our subset of patients,treatment delivery,surgery rates and toxicity profile were comparable to the seminal FLOT4 trial.Our histological responses are lower with pathCR in only 2.8% (vs 16%)patients,with most having TRG 3.The survival rates are better but a longer followup is required.
Clinical trial identification
n/a
Editorial acknowledgement
Nil
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.