Real world experience from the use of neoadjuvant FLOT in patients with resectable oesophageal, gastrooesophageal junction (GOJ) and gastric adenocarcinomas. A Yorkshire network audit.


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Danny Ulahannan1,Konstantinos Kamposioras2,Jeremy Hayden1,Daniel Swinson1,Jonathan Wadsley3,Jessica Tay3,Usman Ahmad4,Simon Brown5,Sohail Mughal5,Jo Dent6,Elizabeth Appleton6,Rajarshi Roy7,Ornella Belvedere8,Kim Last8,Mohan Hingorani1,Matt Seymour1
1Leeds Teaching Hospital,2Christie Hospital,3Weston Park cancer centre, Sheffield,4Mid Yorkshire hospital NHS trust,5Bradford Teaching hospital,6Calderdale and Huddersfield NHS trust,7Hull University teaching hospital,8York teaching hospital

Abstract

Background

FLOT is a new standard of care for patients requiring perioperative chemotherapy for adenocarcinomas of GOJ and gastric origin (Al-Batran et al, Lancet 2019). Real world experience utilising FLOT is important for clinical practice.

 

Method

This is a retrospective audit of patients treated with neoadjuvant FLOT between October 2017 and February 2019 in the Yorkshire and Humber regions. Baseline clinicopathological parameters, chemotherapy information (e.g. number of cycles, dose modifications, toxicity) and surgical outcomes were captured. Selected patients were offered postoperative FLOT.    

 

Results

Preliminary results from four out of seven centres account for 70 patients treated with neoadjuvant FLOT: 57 males and 13 females (median age 65 years, range 26-79 years). Location of the tumour was 30 oesophageal, 30 GOJ and 10 gastric. Clinical stage varied from T2N0 to T4aN3. 56/70 (80%) of patients completed 4 cycles of preoperative chemotherapy, with 32/70 (46%) of patients requiring a dose reduction, the commonest causes being fatigue and neuropathy. 62/69 (90%) of patients underwent surgery. The median time from start of last cycle of FLOT to surgery was 43 days (range 27-81). An R0 resection was achieved in 55/62 (89%) of patients; 36/62 (58%) of patients had ypN0 stage and 19/62 (30%) of patients had yp≤T1. Postoperative complications occurred in 17/62 (27%) of patients including pneumonia, anastomotic leaks, ischaemic bowel and venous thromboembolic events. One patient died in the immediate postoperative phase secondary to mediastinal infection.

Conclusion

The results compare favourably with the FLOT4 trial where 90% of patients completed 4 cycles of FLOT; 97% underwent surgery; R0, yp≤T1 and ypN0 rates were 85%, 25% & 49% respectively.   Time to surgery was longer in our population.  Final results of our audit including data from all centres will be presented at the meeting.