Abstract 1233P
Background
Peri-operative 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) or neoadjuvant carboplatin, paclitaxel with radiation (CROSS) has become the standard of care for locally advanced gastro-oesophageal junction (GOJ) and oesophageal cancer (OC). Currently head to head comparisons of the 2 regimens are lacking. This study aims to evaluate, using real-world data, the efficacy and toxicity difference of FLOT and CROSS for the treatment of GOJ and OC adenocarcinomas.
Methods
This is a retrospective multi-center observation study of patients from 5 centres in Western Sydney with locally advanced histological confirmed GOJ or OC adenocarcinoma treated with FLOT or CROSS between 2015 and 2021. Treatment recommendations were based on expert consensus from multidisciplinary team meetings. Overall survival (OS) was defined from time of diagnosis (TOD) to death from any cause. Relapse free Survival (RFS) was defined from TOD to first occurrence of disease progression, relapse, or death. Log-rank test was used to estimate a difference between OS/RFS. Hazard ratios for univariate and multivariate analysis was estimated using cox-proportional hazard. Toxicity was graded as per the Common Terminology Criteria for Adverse Events version 5.0.
Results
Of the 104 patients, 34 (33%) received FLOT and 70 (67%) had CROSS. There was no difference in OS or RFS between treatments. The hazard ratio for death for FLOT compared to CROSS on univariate and multivariate analysis was 0.97 (95% CI 0.49-1.95 p-value>0.9) and 1.33 (95% CI 1.33(0.39-4.49, p=0.649) respectively. No significant difference in complete pathological response (20% (CROSS), 30% (FLOT)) was seen. Recurrence occurred in 41% (79% distant) of CROSS treated patients compared to 32% (63% distant) in FLOT. 85% and 29% of FLOT treated patients completed 4 and 8 cycles of treatment, respectively(vs 75% completing CROSS treatment). Patients receiving FLOT had more statistically significant clinically relevant grade 2 and 3 toxicity than those with CROSS.
Conclusions
CROSS and FLOT had similar efficacy outcomes in the treatment of GOJ and OC adenocarcinoma. However FLOT appeared to be less well tolerated with more discontinuations.
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.