Gastric Cancer · Medical Oncology
FLOT4-AIO
In resectable gastric or GEJ adenocarcinoma, does perioperative FLOT improve survival compared with ECF/ECX?
Population
716 patients with resectable gastric or gastroesophageal-junction adenocarcinoma
5-year OS
≈45% vs 36%
Absolute improvement ≈9 points; NNT 12
Median OS
50 vs 35 months
HR 0.77 (95% CI 0.63–0.94)
Treatment burden
FLOT is a more intensive perioperative regimen with substantial haematologic and gastrointestinal toxicity.
Absolute Effect
NNT: 12, based on approximately 5-year overall survival. The absolute survival gain is clinically meaningful, while the regimen is more intensive than ECF/ECX.
NNH: not quantified. No single prespecified toxicity endpoint is sufficiently central here for a defensible NNH; the treatment burden should be considered directly.
Clinical interpretation
FLOT4 established FLOT as a more effective perioperative chemotherapy backbone for resectable gastric and GEJ adenocarcinoma. The benefit comes with greater treatment intensity and requires appropriate patient selection.
Primary source
Al-Batran SE, et al. Lancet. 2019;393:1948–1957.