Safety and efficacy of perioperative FLOT regimen in Japanese patients with gastric, esophagogastric junction, or esophageal adenocarcinoma: A single-institution experience

Abstract

Abstract Background Although the common treatment strategy for localized gastric cancer in Japan is gastrectomy followed by adjuvant chemotherapy, several randomized studies in non-Japanese populations have established perioperative chemotherapy as the standard treatment for localized gastric or gastroesophageal junction adenocarcinoma. Therefore, we have implemented this strategy in our institution. Methods We retrospectively reviewed the medical records of patients with resectable gastric cancer, gastroesophageal junction cancer, and esophageal adenocarcinoma who had received perioperative FLOT from February 2020 to November 2021. Results In this study, a total of 48 patients were analyzed, with a median age of 70 years (range: 29–82). At the time of diagnosis, 46 patients (95.8%) had T3 or higher-grade primary lesions, and 43 (90%) had lymph node metastasis. Seven patients had resection before completing four cycles of preoperative chemotherapy, and 37 of 48 (77.1%) completed four cycles with 35 of these receiving radical resection. Among the 42 patients who had radical resection after FLOT, 41 (97.6%) achieved R0 resection, including 4 (9.5%) with a pathological complete response. After resection, 29 patients (60.4%) received at least one cycle of postoperative FLOT, and 20 (41.7%) completed eight cycles of FLOT treatment. Chemotherapy-related adverse events of Grade 3 or higher occurred during the pre- and postoperative FLOT in 41 patients (85.4%), including leukopenia (52.1%), neutropenia (83.3%), febrile neutropenia (8.3%), and anorexia (10.4%). No treatment-related deaths occurred. Conclusions These findings were comparable to those in the pivotal FLOT 4 study, suggesting acceptable feasibility of the FLOT regimen in Japanese clinical practice.