Upper GI: Perioperative chemotherapy gastric (FLOT4 vs MAGIC)

Why D is correct

The FLOT4 trial showed that perioperative FLOT improved median overall survival to 50 months versus 35 months with ECF/ECX (HR 0.77; p=0.012) and achieved a higher pathological complete response rate (16% versus 6%) in resectable gastric or gastro-oesophageal junction adenocarcinoma. FLOT is therefore the preferred perioperative regimen for fit patients, superseding the MAGIC (ECF) regimen.

And why the others are not

• AGEMCAP is an induction regimen in locally advanced pancreatic cancer (SCALOP), not a perioperative gastric cancer regimen.
• BECX was part of the ECF/ECX comparator arm shown to be inferior to FLOT in FLOT4.
• CECF was the comparator (MAGIC-type) arm in FLOT4 and was inferior to FLOT for both survival and pathological response.
• ECisplatin-capecitabine plus trastuzumab is the regimen for HER2-positive metastatic disease, not the standard perioperative regimen for localised gastric cancer.

Source FLOT4 - Perioperative FLOT versus ECF/ECX in resectable gastric or GOJ adenocarcinoma — Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948-1957.