P-375 Perioperative FLOT in locally advanced and gastroesophageal junction cancer: A real-word experience in Argentina

Gastric cancer is a disease with a high mortality rate, even in early stages. The combination of surgery with perioperative systemic treatment with the FLOT regimen, based on fluoropyrimidines, oxaliplatin, and docetaxel, has become the standard of care for patients with locally advanced UGE and stomach tumors. The aim of this study is to share the experience of using and tolerating this strategy in our setting. Retrospective observational study carried out in a university hospital in Buenos Aires, Argentina to evaluate the efficacy and safety of perioperative FLOT in patients with locally advanced gastric cancer. Patients with a histological diagnosis of locally advanced and resectable gastric adenocarcinoma who received FLOT as perioperative therapy from 2018 to 2022 were included. A total of 34 patients were included. The median age at diagnosis was 59 years IQR (52-69). 11 patients (32%) had a signet ring cell pattern, and 7 (21%) overexpressed HER2. An ORR by imaging of 82% was observed in patients who underwent neoadjuvant therapy. 30% of patients did not complete the planned 8 cycles of perioperative FLOT, 5 did not undergo any adjuvant cycles, and 4 (12%) did not proceed to surgery due to disease progression. The pCR rate was 12.5% (4 patients). 55% of patients had to delay at least one cycle of treatment due to hematologic toxicity, and one patient died of febrile neutropenia. With a median follow-up of 25 months, 20 patients (59%) relapsed, with a median time to relapse of 16 months. During follow-up, 12 patients died, with a median overall survival of 44 months from diagnosis. The perioperative FLOT regimen had higher toxicity and was less tolerated than expected, and this was translated into unfavorable clinical outcomes in our cohort. This real-life study demonstrates the lower compliance of polychemotherapeutic regimens in unselected patients with early resectable gastric cancer.