Perioperative FLOT vs EOX regimen and non-metastatic gastric carcinoma survival outcomes: Real-world data from a tertiary cancer centre, India.

Abstract

e16125 Background: Gastric carcinoma contributes to the leading cancer sites worldwide. The current standard of care is using a perioperative FLOT regimen, which was based on the trial by Al-Batran et al FLOT4-AIO study. This retrospective study intends to compare FLOT vs EOX regimens in a periop setting. Aim To compare FLOT (fluorouracil plus leucovorin, oxaliplatin and docetaxel) vs EOX regimen (Epirubicin, oxaliplatin and capecitabine) in the perioperative setting of non-metastatic gastric carcinoma. Objective 1. To analyse FLOT vs EOX event-free survival (EFS) and overall survival (OS) in the perioperative setting. 2. To find prognostic factors influencing survival in FLOT and EOX recipients. 3. To analyse the effect of dose modification on survival in FLOT vs EOX. Methods: This is a descriptive study with retrospective analyses. Patient's clinical data were retrieved from the Tumor registry (Jan 2017 to May 2023) after Institute Ethics approval. The clinical data of stage II to III biopsy-proven gastric carcinoma patients were used for analyses. The EFS was calculated from the date of diagnosis till progression/recurrence or death due to disease or any cause and OS was calculated from the date of diagnosis till death due to any cause. Statistical analyses were performed using SPSS software. The log rank was used for univariate analysis. The survival was plotted as per Kaplan-Meier. Results: 381 patients were analysed in the perioperative setting, 205 in the FLOT and 176 in the EOX group. 99.5% were deemed unresectable and majority were stage III. The FLOT group showed a nonsignificant favourable median OS (not reached vs 23.9 months) and median EFS (19.8 vs 15.9 months) at a median follow-up of 38.6 months compared to EOX. The pCR rates were 3.9% vs 3.4% between FLOT vs EOX. The R0 resection rates (63.4% vs 50.5%) were better with FLOT vs EOX. The number of cycles ( > 3), resectability and objective response showed a significant impact on OS and EFS benefits in both regimens. The dose modification was found to influence survival in EOX group. 3yr EFS between FLOT vs EOX was 41.6% vs 37.7% and 3yr OS was 53.2% vs 44.9% respectively. Conclusions: FLOT regimen showed nonsignificant favourable survival outcomes compared to EOX. FLOT maintained the 9% absolute OS benefit despite dose modification in the locally advanced stage.