Perioperative chemotherapy

In the randomized phase III AIO-FLOT4 trial (NCT01216644), 716 patients with stage IB to stage III resectable gastric or gastroesophageal adenocarcinoma were randomly assigned to receive either perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil (5-FU)/leucovorin (FLOT) or epirubicin, cisplatin, and 5-FU or capecitabine (ECF/ECX).[8][Level of evidence A1]

In the randomized phase III AIO-FLOT4 trial (NCT01216644), 716 patients with stage IB to stage III resectable gastric or gastroesophageal adenocarcinoma were randomly assigned to receive either perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil (5-FU)/leucovorin (FLOT) or epirubicin, cisplatin, and 5-FU or capecitabine (ECF/ECX).[8][Level of evidence A1]

Median overall survival (OS) was 50 months with FLOT and 35 months with ECF/ECX (hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.63–0.94; P = .012).

In the randomized phase III AIO-FLOT4 trial (NCT01216644), 716 patients with stage IB to stage III resectable gastric or gastroesophageal adenocarcinoma were randomly assigned to receive either perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil (5-FU)/leucovorin (FLOT) or epirubicin, cisplatin, and 5-FU or capecitabine (ECF/ECX).[8][Level of evidence A1]

Margin-free resection in the FLOT group was 85% versus 78% in the ECF/ECX group (P = .0162).

In the randomized phase III AIO-FLOT4 trial (NCT01216644), 716 patients with stage IB to stage III resectable gastric or gastroesophageal adenocarcinoma were randomly assigned to receive either perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil (5-FU)/leucovorin (FLOT) or epirubicin, cisplatin, and 5-FU or capecitabine (ECF/ECX).[8][Level of evidence A1]

Toxicity rates were similar between groups (26% required hospitalizations in the ECF/ECX group and 25% in the FLOT group). However, types of side effects differed, with increased nausea, thromboembolic events, and anemia in the ECF/ECX group versus higher rates of grade 3/4 infections, neutropenia, diarrhea, and neuropathy in the FLOT group.

In the randomized phase III MAGIC trial (NCT00002615), patients with stage II or higher adenocarcinoma of the stomach or of the lower third of the esophagus were assigned to receive three cycles of epirubicin, cisplatin, and continuous infusion 5-FU (ECF) before and after surgery or to receive surgery alone.[2]

In the randomized phase III MAGIC trial (NCT00002615), patients with stage II or higher adenocarcinoma of the stomach or of the lower third of the esophagus were assigned to receive three cycles of epirubicin, cisplatin, and continuous infusion 5-FU (ECF) before and after surgery or to receive surgery alone.[2]

Compared with the surgery group, the perioperative chemotherapy group had a significantly higher likelihood of progression-free survival (HRprogression, 0.66; 95% CI, 0.53–0.81; P < .001) and of OS (HRdeath, 0.75; 95% CI, 0.60–0.93; P = .009).

In the randomized phase III MAGIC trial (NCT00002615), patients with stage II or higher adenocarcinoma of the stomach or of the lower third of the esophagus were assigned to receive three cycles of epirubicin, cisplatin, and continuous infusion 5-FU (ECF) before and after surgery or to receive surgery alone.[2]

The 5-year OS rate was 36.3% (95% CI, 29.5%‒43.0%) for the perioperative chemotherapy group and 23% (95% CI, 16.6%‒29.4%) for the surgery group.[2][Level of evidence A1]