FLOT4

• 5-Fluorouracil

• Leucovorin

• Oxaliplatin

• Docetaxel (Taxotere)

• FLOT4-AIO Trial

  • FLOT4, page 1, (Lancet 2019)
  • Inclusion
    • Adenocarcinoma of stomach, GOJ, T2+, any N
      • 56% GOJ
  • Arms
    • Compared FLOT4 (4 cycles pre/post) vs. ECF (MAGIC) or ECX (capecitabine) (3 cycles pre/post)
  • Results
    • Overall survival better – 50 months vs 36 months
    • High tolerance of FLOT not replicated clinically
    • Standard of care for Gastric Ca and often used in Lower Oesophageal Ca

This trial essentially compared FLOT4 with ECF from the MAGIC Trial

• Difference = Taxane added, and 4 x pre-op and 4 x post-op rounds (cf Magic trial x3) - More toxic!

5 year for FLOT 45% and for magic was 36%

• ESOPEC trial
  • NEJM 2025
    • ESOPEC, page 1
    • Methods
      • RCT - FLOT4 vs CROSS Trial
      • Inclusion: cT1 cN+, cT2–4a cN+, or cT2–4a cN0 disease
        • Excluded T1 N0, T4b
      • Primary end pointL overall survival
    • Results
      • FLOT4: 221 and CORSS 217 patients
      • OS 57% FLOT vs 50% CROSS - HR 0.7 for death
      • Progression free survival - 51% FLOT, 35% CROSS
      • Adverse event (g3 or above) 58% FLOT vs 50% CROSS
      • Mortality 3.1% FLOT vs 5.6% CROSS
    • Conclusion
      • FLOT led to improved survival