Histopathological regression after taxane based neoadjuvant chemotherapy in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma

We read with great interest the phase 2 randomized trial FLOT4-AIO. Al-Batran et al. have published the results of the phase 2 part of this phase 2/3 randomized controlled trial (RCT). They have compared FLOT (Docetaxel, Oxaliplatin, 5FU and leucovorin) regimen to the standard neoadjuvant regimen [ECX/epirubicin, cisplatin and 5-flourouracil (ECF)] (1). The primary end point for this trial was tumour regression grade (TRG1a as per Becker’s criteria) of primary tumor. All age group of patients with non-metastatic gastric and esophagogastric junction adenocarcinoma (GaCaGEJ), > cT2 and/or N+ve, were included and patients with adjacent organ invasion were excluded. The groups compared included 137 patients in ECX/ECF vs. 128 in FLOT group in a modified intention to treat analysis. The significant findings included an improved resectability rate, favorable pT stage and R0 resection rate with the use of FLOT. FLOT also resulted in an improved overall TRG1a and TRG1a + 1b and an improved TRG1a + 1b in the intestinal histology, without any increase in perioperative outcomes and non-surgical adverse events (1)