Zhang Yonglei, Zhang Bin, Yang Jinpo, Zhang Jindai, Zhang Wei
Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, Henan Province, People's Republic of China.
Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450008, Henan Province, People's Republic of China.
Cancer Manag Res. 2021 Mar 10;13:2279-2286. doi: 10.2147/CMAR.S304093. eCollection 2021.
The trend in neoadjuvant therapy for locally advanced gastric cancer (LAGC) is to use more drugs or therapies in combination. This study aimed to assess the safety and effectiveness of neoadjuvant chemotherapy with fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) plus apatinib in the treatment of LAGC.
We collected clinical data from patients with LAGC who received neoadjuvant FLOT and apatinib therapy and underwent surgery from January 2017 to December 2020. Patients were divided into either the FLOT group (in which patients received FLOT neoadjuvant therapy and surgery) or the FLOTA group (in which patients received FLOT plus apatinib neoadjuvant therapy and surgery).
The FLOT and FLOTA groups contained 44 and 31 patients, respectively. There were significant differences between the FLOT and FLOTA groups in the objective response rate (50.00% vs. 80.65%, respectively, p = 0.008) and average change from baseline in the target lesion size (-26.16 ± 34.61 vs. -54.32 ± 36.11, respectively, p < 0.001). There were also significant differences in the pretreatment clinical tumor-node-metastasis (cTNM) and post treatment cTNM stages for the FLOT group (p = 0.001) and for the FLOTA group (p < 0.001). There were no significant differences between the FLOT and FLOTA groups in post neoadjuvant therapy cTNM stages (p = 0.525), R0 rate (p = 0.397), tumor regression grade (p = 0.397), or post treatment pathological TNM stage (p = 0.180). Some neoadjuvant therapy-related adverse events occurred significantly more frequently in the FLOTA group, including diarrhea (all grades), pain (all grades), oral mucositis (all grades), and hand-foot syndrome (all grades).
The FLOTA regimen can achieve better perioperative efficacy and acceptable toxicity compared with that of the FLOT regimen in neoadjuvant treatment of LAGC. The FLOTA regimen for neoadjuvant therapy for LAGC merits further study.
局部晚期胃癌（LAGC）新辅助治疗的趋势是联合使用更多药物或治疗方法。本研究旨在评估氟尿嘧啶、亚叶酸钙、奥沙利铂和多西他赛（FLOT）联合阿帕替尼新辅助化疗治疗LAGC的安全性和有效性。
我们收集了2017年1月至2020年12月期间接受新辅助FLOT和阿帕替尼治疗并接受手术的LAGC患者的临床资料。患者分为FLOT组（接受FLOT新辅助治疗和手术）或FLOTA组（接受FLOT加阿帕替尼新辅助治疗和手术）。
FLOT组和FLOTA组分别有44例和31例患者。FLOT组和FLOTA组在客观缓解率（分别为50.00%和80.65%，p = 0.008）以及靶病灶大小相对于基线的平均变化（分别为-26.16±34.61和-54.32±36.11，p < 0.001）方面存在显著差异。FLOT组（p = 0.001）和FLOTA组（p < 0.001）在治疗前临床肿瘤-淋巴结-转移（cTNM）和治疗后cTNM分期方面也存在显著差异。FLOT组和FLOTA组在新辅助治疗后cTNM分期（p = 0.525）、R0切除率（p = 0.397）、肿瘤退缩分级（p = 0.397）或治疗后病理TNM分期（p = 0.180）方面无显著差异。一些新辅助治疗相关的不良事件在FLOTA组中发生频率明显更高，包括腹泻（所有级别）、疼痛（所有级别）、口腔黏膜炎（所有级别）和手足综合征（所有级别）。
在LAGC的新辅助治疗中，与FLOT方案相比，FLOTA方案可实现更好的围手术期疗效和可接受的毒性。LAGC新辅助治疗的FLOTA方案值得进一步研究。
