FLOT VERSUS FOLFOX/XELOX AS PERIOPERATIVE CHEMOTHERAPY IN RESECTABLE GASTRIC ADENOCARCINOMA

Background: The perioperative use of the FLOT regimen has become the standard-of-care for patients (pts) with ≥ cT2cN0 non-metastatic gastric cancer. Due to its greater toxicity, regimens such as FOLFOX or XELOX have been used as an alternative in clinical practice. However, the use of these regimens perioperatively has never been compared in randomized studies. Methods: This is a multicentric retrospective cohort, where data collection was carried out from electronic medical records from 2015 to 2020. Baseline patient and disease characteristics were compared using Student’s t-test, Mann–Whitney U-test, Fisher’s exact test, or Chi-square test whenever appropriate. Disease-Free Survival (DFS) and Overall Survival (OS) were compared using the Kaplan-Meier method. Multivariable Cox regression models were used to calculate adjusted HR for possible confounding factors. Results: Ninety-four pts were included (42.5% treated with FLOT and 57.4% with a doublet regimen). Pts treated with a doublet regimen tended to be older (median age: 61.5 vs. 58; P = 0.18) and with a worse performance status (ECOG 2 or 3: 19.2% vs. 8.1%; P = 0.22). FLOT and doublet groups had similar rates of preop- (77.5 vs. 74%) and postoperative (37.5 vs. 31.5%) treatment completion. With a median follow-up of 29.1 months, both median DFS (22.9 vs. 13.8 months; HR 0.63 95%CI 0.36 – 1.10; P = 0.1) and OS (not reached vs. 21.1 months; HR 0.26 95%CI 0.12 – 0.57; P < 0.001 ) favored treatment with FLOT even after adjustment for confounders. Conclusion: Our study suggests that FLOT should be used whenever possible. To date, the use of doublet regimens would only be justified in pts with poor performance status and/or multiple comorbidities or in scenarios where docetaxel is not available.