Perioperative FLOT Chemotherapy in Resectable Gastric Adenocarcinoma: A Single-center Retrospective Observational Study.

Abstract

Introduction: Gastric cancer (GC) is a leading cause of cancer-related mortality worldwide. Perioperative chemotherapy improves tumor downstaging and survival rates. The FLOT regimen was proven superior in the FLOT4-AIO trial, establishing it as the standard care for resectable gastric adenocarcinoma. Despite these encouraging results from randomized controlled trials, real-world data on the feasibility and outcomes of FLOT in diverse patient populations, particularly in low- and middle-income settings, remain limited. This study aimed to assess the feasibility, safety, and clinical outcomes of perioperative FLOT chemotherapy in patients with resectable gastric adenocarcinoma at a tertiary care center.

Materials and methods: We conducted a retrospective review of the medical records of patients diagnosed with resectable gastric adenocarcinoma who received perioperative FLOT chemotherapy between April 2019 and April 2025. The primary outcomes were the feasibility of perioperative FLOT chemotherapy and pathological complete response (pCR). The secondary outcomes were surgical outcomes, treatment adherence, and adverse events (AEs).

Results: The results showed that 64.4% of patients completed at least four cycles of neoadjuvant FLOT, while only 24.4% underwent surgical resection. No pathological complete responses were observed. Grade 3-4 AEs occurred in 18.1% of patients, primarily cytopenias. A high rate of loss to follow-up (45.4%) was noted in the preoperative phase.

Conclusion: While FLOT demonstrated an acceptable safety profile, the lower-than-expected surgical resection rate and high attrition highlight the challenges in managing locally advanced gastric cancer in real-world settings. This study emphasizes the need for strategies to improve treatment adherence and optimize patient selection to maximize the benefits of perioperative chemotherapy for gastric cancer.