Dr. Ilson Discusses the Optimal Adjuvant Therapy for Resectable Gastric Cancer

David H. Ilson, MD, PhD, medical oncologist, Memorial Sloan Kettering Cancer Center, discusses a trial from Germany comparing standard perioperative ECF/ECX chemotherapy with a regimen combining 5-FU (5-fluorouracil) with oxaliplatin and docetaxel.

This trial, presented at the 2017 ASCO Annual Meeting, involved a head-to-head comparison of perioperative docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) for every 2 weeks for 4 cycles before surgery, and 4 cycles after surgery to standard perioperative ECF for typically 3 pre- and 3 postoperative cycles. Pilot data for the regimen were based on the knowledge that taxing triplets are more active in metastatic disease versus a chemotherapy doublet.

The primary endpoint of the study was overall survival (OS), and preliminary data from phase II revealed overall superiority compared with ECF. The FLOT regimen had a higher pathologic complete response rate and curative resection rate of approximately 7%. A 7% to 8% improvement in complete remission rates was also reported.

This new regimen suggests a new standard of care for perioperative chemotherapy in gastric cancer, Ilson concludes.