Pathological regression as an indicator of the effectiveness of perioperative FLOT/FOLFOX in patients with resectable gastric cancer


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Abstract

Background. Gastric cancer remains one of the leading causes of cancer death worldwide, with an estimated 753,000 deaths each year. The question for clinicians is whether we need to intensify the drug regimen to achieve significant pathological responses (TRG 1-2) in more patients. Objective. Evaluation and comparison of the pathomorphological responses (Mandard TRG) from patients with locally advanced gastric adenocarcinoma who underwent neoadjuvant chemotherapy (NACT) in the FLOT or FOLFOX regimens and radical surgery, based on our database of the City Clinical Oncology Dispensary, as well as evaluation of the TRG grade in patients with different status of regional lymph nodes. Methods. A prospective study included 123 patients with locally advanced gastric cancer who underwent neoadjuvant chemotherapy (NAHT) in the FLOT or FOLFOX regimens; the stratification of patients was carried out according to the general condition of the patient: ECOG=0 versus ECOG=1.2. Results. In the group of patients treated with NACT in the FLOT regimen, a complete pathomorphological response was registered in 10.81% (8/74) of cases; in the group of patients treated with NACT in the FOLFOX regimen - in 13.95% (6/43) (P=0.6139). A complete pathomorphological response (TRG1-2) was registered in 27.03% (20/74) of cases in the group of patients treated with FLOT, and in 23.26% (10/43) of cases in the group of patients treated with FOLFOX (P=0, 6525). The frequency of down staging in the group of patients treated with FLOT was 48.75% (39/80), in the group of patients treated with FOLFOX - 55.56% (25/45) (P=0.4647). Conclusion. Our results indicate comparable pathomorphological responses when using the FLOT and FOLFOX regimens in neoadjuvant treatment regimens for locally advanced gastric cancer.

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About the authors

N. P Belyak

City Clinical Oncology Dispensary; St. Petersburg State University

St. Petersburg, Russia; St. Petersburg, Russia

R. V Orlova

City Clinical Oncology Dispensary; St. Petersburg State University

St. Petersburg, Russia; St. Petersburg, Russia

Svetlana I. Kutukova

City Clinical Oncology Dispensary; Pavlov University

Email: dr.s.kutukova@gmail.com
Cand. Sci. (Med.), Associate Professor at the Department of Dentistry, Surgical and Maxillofacial Surgery; Oncologist at the Department № 10 (Chemotherapy) St. Petersburg, Russia; St. Petersburg, Russia

Yu. V Pelipas

City Clinical Oncology Dispensary

St. Petersburg, Russia

A. V Androsova

City Clinical Oncology Dispensary; St. Petersburg State University

St. Petersburg, Russia; St. Petersburg, Russia

N. V Zhukova

City Clinical Oncology Dispensary; St. Petersburg State University

St. Petersburg, Russia; St. Petersburg, Russia

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