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Efficacy and tolerability of fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) in unselected patients with advanced gastric and gastroesophageal cancer: does age really matter?

  • Original Article – Clinical Oncology
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Abstract

Purpose

Fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) regimen has shown strong efficacy as perioperative therapy for patients with locally advanced gastric (GC) and gastroesophageal (AEG) carcinoma. In the palliative situation, FLOT is recommended only for young fit patients. Data of efficacy and tolerability of FLOT in elderly patients are scarce and controversial. Thus, this study aimed to provide real-life experience of elderly patients with GC and AEG treated with FLOT as first-line palliative chemotherapy.

Methods

Patients with advanced or metastatic GC or AEG and treated with FLOT as first-line palliative therapy between 2010 and 2021 were analyzed. Patients were grouped into < 65 years old (n = 35) and ≥ 65 years old (n = 22) groups. Overall survival (OS), progression-free survival (PFS), feasibility and toxicity were analyzed.

Results

The median OS was 10.4 months with no significant difference between both groups (HR 0.86; 95% CI 0.48, 1.57; p = 0.632). The ECOG performance status showed powerful influence on OS in the subgroup analysis with median OS of 12.3 months for ECOG = 0 compared to 5.0 months for ECOG ≥ 1 (p = 0.015) as well as in multivariate analysis (HR 2.62; 95% CI 1.36, 5.04; p = 0.004).

Conclusion

In the present study the ECOG performance status showed a stronger prognostic value than patient age in FLOT as first- line therapy in a real-life cohort with advanced and metastatic GC and AEG. The performance status should therefore be considered in the therapeutic decision making of elderly patients with GC and AEG.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

This work was supported by the following grants awarded to M.A. Gonzalez-Carmona: GO 1874/1-2 grant from Deutsche Forschungsgemeinschaft (DFG), BONFOR from the University of Bonn, grant number 109255 from Deutsche Krebshilfe (German Cancer Aid) and grant from the Reuthersche endowment fund of the University of Bonn.

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  1. Christian Möhring and Aliki Timotheou contributed equally.

Authors and Affiliations

  1. Department of Internal Medicine I, University Hospital of Bonn, Venusberg Campus 1, 53127, Bonn, Germany

    Christian Möhring, Aliki Timotheou, Adrianna Mańczak, Farsaneh Sadeghlar, Taotao Zhou, Robert Mahn, Alexandra Bartels, Malte Monin, Christian P. Strassburg & Maria A. Gonzalez-Carmona

  2. Department of Pathology, University Hospital of Bonn, Bonn, Germany

    Marieta Toma

  3. Department of Internal Medicine III, University Hospital of Bonn, Bonn, Germany

    Georg Feldmann & Peter Brossart

  4. Department of Radiation Oncology, University Hospital of Bonn, Bonn, Germany

    Mümtaz Köksal, Gustavo R. Sarria & Frank A. Giordano

  5. Department of Surgery, University Hospital of Bonn, Bonn, Germany

    Philipp Lingohr, Azin Jafari & Jörg C. Kalff

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  1. Christian Möhring
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Contributions

Study concept, data collection and analysis, and interpretation of data were designed and performed by CM, AT and MAG-C. The first draft of the manuscript was written by CM, AT and MAG-C and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Maria A. Gonzalez-Carmona.

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Author MG has contributed to advisory boards for Roche, Eisai, BMS, MSD and AZ. However, these activities have no potential conflicts of interest with the manuscript. None of the other authors have any potential conflicts (financial, professional or personal) that are relevant to the manuscript.

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Möhring, C., Timotheou, A., Mańczak, A. et al. Efficacy and tolerability of fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT) in unselected patients with advanced gastric and gastroesophageal cancer: does age really matter?. J Cancer Res Clin Oncol 149, 1849–1862 (2023). https://doi.org/10.1007/s00432-022-04109-8

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