USE OF FLOT 4 PERIOPERATIVE CHEMOTHERAPY IN PATIENTS WITH GASTRIC CANCER TREATED IN PUBLIC HEALTH SYSTEM: IS IT FEASIBLE AND SAFE EVEN IN NON CANCER CENTERS?

Introduction: The FLOT-4 (fluorouracil, leucovorin, oxaliplatin and docetaxel) perioperative chemotherapy (CT) regimen is consider a standard of care for localized or locally advanced gastric (GC) or gastroesophageal (GEJ) junction adenocarcinoma. Objective: Evaluate the feasibility and tolerance of the use of FLOT-4 perioperative CT regimen in patients (pts) with gastric cancer treated in the brazilian public health system. Methods: This is a collaborative retrospective study of two general hospitals that attend the Brazilian public health system. Eligible criteria included pts initially diagnosed with localized, locally advanced or oligometastatic GC or GEJ adenocarcinomas that after multidisciplinary discussion received FLOT-4 perioperative CT by at least one cycle with potential curative intention between january 2019 and december 2020. All data was collected by electronic medical charts. Results:We included a total of 31 pts in this analysis. The median age was 57 years old, being 58% (n=18) of male and 51.6% (n=16) had signet ring subtype. The main symptom at the cancer presentation was weight loss (n=13 ; 44,8%) and median body mass index pre-FLOT and after 4 cycles were 24,1 and 23,7, respectively. The median interval between upper endoscopic to oncology consultant, oncology consultant to CT initiation and last cycle of pre-operative CT to surgery was 26, 7 and 45 days, respectively. Because of limited access, only one of each four pts did diagnostic laparoscopy at baseline. All pts completed the preoperative 4 cycles of FLOT. Analysis of serious side effects was performed by each cycle. We observed an increased incidence after surgery: in the pre and postoperative phases ranged between 4-21% and 22-40%, respectively and nausea/vomiting, neutropenia and asthenia were the most frequent (20% each) reported. Twelve (38%) pts had CT dose reduction and none grade 5 toxicity was identified. Only 70% (n=22) of pts underwent definitevely surgery, of which 36.4% (n=8) underwent subtotal gastrectomy and 27.3% (n=6) underwent only palliative surgery. Conclusion:Treatment with FLOT 4 perioperative CT was feasible and safe in our reality and can be executed in a similar fashion as in the pivotal trial even in public brazilian non cancer center hospitals. Otherwise, we believe that to achieve this goal it is mandatory to have a dedicated multidisciplinary team in order to be vigilant to intervals between procedures and compromise with efficient and safety of pts.