2052P - Adverse events in FLOT chemotherapy for locally advanced gastric cancer: An observational study of pre- and post-operative toxicity profiles

Background

Fluorouracil plus leucovorin, oxaliplatin and docetaxel (FLOT) is the standard of care for perioperative chemotherapy in resectable locally advanced gastric cancer (LAGC) in Europe. As a triplet combination, FLOT may be associated with increased toxicity. Therefore, it is crucial to investigate whether patients experience similar toxicities before and after surgery. This study aims to evaluate the toxicity profile of FLOT chemotherapy.

Methods

This observational, longitudinal, retrospective study included patients diagnosed with LAGC and treated with FLOT chemotherapy in a Portuguese medical oncology department between January 2018 and December 2020. Adverse events were classified according to Toxicity Grading CTC-AE version 5.0.

Results

Forty-seven patients with LAGC treated with FLOT chemotherapy were included in this study. The median age at diagnosis was 59.3 years (SD 8.1), and the majority of patients were male (n=29, 61.7%) with an ECOG PS of 0 (n=41, 87.2%). During the first four cycles of FLOT given before surgery, a total of 56 adverse events of any degree were observed, with 8 (17%) patients requiring treatment delay and 4 (8.5%) patients requiring dose reduction. In the 5th to 8th cycles given after surgery, there were 62 adverse events of any degree, with 13 (27.7%) patients requiring treatment delay and dose reduction. Notably, the toxicity profile differed between the pre and post-operative periods. In the first 4 cycles, the most common adverse events were nausea (n=16, 28.6%), emesis (n=9, 16.2%), and diarrhea (n=6, 10.7%), mostly with grade 2 toxicity. In the postoperative period, the main adverse events were neutropenia (n=23, 37.1%), nausea (n=6, 9.7%), and neuropathy (n=6, 9.7%). Grade 3 and 4 neutropenia occurred in 15 and 2 patients, respectively. Forty-two patients completed 8 cycles of FLOT.

Conclusions

The observed differences in toxicity between the pre- and postoperative periods highlight the importance of tailoring the treatment approach based on the patient's individual needs. Efforts to minimize dose reduction and chemotherapy delay should be made to maximize the effectiveness of FLOT therapy. Limitations of this study include the lack of data on long-term toxicity.

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.