Debate Assesses FLOT vs CROSS in GEJ Adenocarcinoma

Yanghee Woo, MD, surgical oncologist in the Division of Surgical Oncology, associate professor in the Department of Surgery, vice chair of international affairs, director of the Gastroenterology and Minimally Invasive Therapies Program at City of Hope, discusses a debate which focused on determining the best neoadjuvant therapy for patients with gastroesophageal junction adenocarcinoma. This debate occurred during the 2024 Society of Surgical Oncology (SSO) Annual Meeting.

The debate specifically focused on the FLOT chemotherapy regimen, which consists of fluorouracil, leucovorin, oxaliplatin, and docetaxel, and the CROSS chemoradiation regimen which consists of of carboplatin and paclitaxel for 5 weeks and concurrent radiotherapy, followed by surgery (chemo XRT). Both of these regimens have become standards of care for this patient population based on trials that were done in 2012 and 2017.

Woo debated on the side of the CROSS regimen for patients with gastroesophageal junction adenocarcinoma while Matthew R. Porembka, MD, associate professor, University of Texas Southwestern Medical Center, argued in favor of FLOT.

Transcription:

0:09 | The debate was talking about FLOT vs CROSS regiments, and I think it brings up the standard of care that was provided for the randomized control trials. The CROSS trial [compared] chemo XRT plus surgery vs surgery alone, which was in 2012.

0:34 | Then FLOT is perioperative, the triple regiment with [fluorouracil, leucovorin, oxaliplatin, and docetaxel, which was published in 2017. These 2 regimens have become the standard of care for gastroesophageal junction adenocarcinoma.

1:03 | However, there are nuances to the studies that were discussed more in detail, and now we have CheckMate 577 [NCT02743494] adding adjuvant nivolumab [Opdivo]. Then we have some evidence about the comparative outcomes of CROSS or CROSS vs perioperative chemotherapy, including [epirubicin, cisplatin plus capecitabine or fluorouracil (Medical Research Council Adjuvant Gastric Infusional Chemotherapy, MAGIC)] plus the FLOT.