Bhargava Prabhat, Das Sudeep, Ostwal Vikas, Srinivas Sujay, Bhandare Manish, Chaudhari Vikram, Bal Munita, Mantri Anoop, Kapoor Akhil, Shrikhande Shailesh V, Ramaswamy Anant
Department of Medical Oncology, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India.
Department of Gastrointestinal and HPB Surgery, Homi Bhabha National Institute (HBNI), Tata Memorial Hospital, Mumbai, Maharashtra, India.
South Asian J Cancer. 2022 Mar 22;11(2):112-117. doi: 10.1055/s-0041-1733349. eCollection 2022 Apr.
Anant Ramaswamy Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT) is a current standard of care for locoregionally advanced gastric adenocarcinomas. There is limited real world data with regard to the tolerance and efficacy of this regimen. This is a retrospective analysis of gastric cancer patients who were offered neoadjuvant perioperative modified FLOT regimen between December 2016 and October 2018, at the Tata Memorial Hospital, Mumbai. Chemotherapy-related side-effects are reported along with overall survival (OS), as calculated by Kaplan-Meier method. Three hundred and forty-three consecutive patients were started on neoadjuvant chemotherapy (NACT) with mFLOT of which 298 patients (87%) completed the planned treatment. A total of 294 patients (86%) underwent curative resection of gastric cancer. Common grade 3 and grade 4 toxicities during NACT were diarrhea in 42 patients (12%) and febrile neutropenia in 27 patients (8%). Toxic death was seen in nine (2.6%) patients. A total of 264 patients (77%) completed planned adjuvant chemotherapy. Common grade 3 and grade 4 toxicities during adjuvant therapy were diarrhea in 42 patients (12%) and febrile neutropenia in 16 patients (6%). With a median follow-up of 19 months, the estimated 2-year median OS was 69.4%. Administration of modified FLOT regimen in locoregionally advanced gastric cancers is feasible in clinical practice with high completion rates, though requiring dose modifications due to the incidence of clinically relevant grade 3 to 5 toxicities. Early outcomes with the regimen are on par with survivals from the FLOT-AIO study.
阿南特·拉马斯瓦米 氟尿嘧啶联合亚叶酸钙、奥沙利铂和多西他赛（FLOT）进行围手术期化疗是目前局部晚期胃腺癌的标准治疗方案。关于该方案的耐受性和疗效，现实世界的数据有限。 这是一项对2016年12月至2018年10月在孟买塔塔纪念医院接受新辅助围手术期改良FLOT方案治疗的胃癌患者的回顾性分析。报告了化疗相关的副作用以及采用Kaplan-Meier法计算的总生存期（OS）。 343例连续患者开始接受新辅助化疗（NACT），采用mFLOT方案，其中298例患者（87%）完成了计划治疗。共有294例患者（86%）接受了胃癌根治性切除术。NACT期间常见的3级和4级毒性反应为腹泻42例（12%），发热性中性粒细胞减少27例（8%）。9例（2.6%）患者出现毒性死亡。共有264例患者（77%）完成了计划的辅助化疗。辅助治疗期间常见的3级和4级毒性反应为腹泻42例（12%），发热性中性粒细胞减少1例（6%）。中位随访19个月，估计2年中位OS为69.4%。 在局部晚期胃癌中应用改良FLOT方案在临床实践中是可行的，完成率高，尽管由于临床相关3至5级毒性反应的发生率需要调整剂量。该方案的早期疗效与FLOT-AIO研究的生存率相当。
