Repository logo
 
Publication

Effect of Neoadjuvant Chemotherapy Followed by Surgical Resection on Survival in Patients With Limited Metastatic Gastric or Gastroesophageal Junction Cancer: The AIO-FLOT3 Trial

2017-09-01Journal article Open access
Simple item page
dc.contributor.authorAl-Batran, SE
dc.contributor.authorHomann, N
dc.contributor.authorPauligk, C
dc.contributor.authorIllerhaus, G
dc.contributor.authorMartens, UM
dc.contributor.authorStoehlmacher, J
dc.contributor.authorSchmalenberg, H
dc.contributor.authorLuley, KB
dc.contributor.authorPrasnikar, N
dc.contributor.authorEgger, M
dc.contributor.authorProbst, S
dc.contributor.authorMessmann, H
dc.contributor.authorMoehler, M
dc.contributor.authorFischbach, W
dc.contributor.authorHartmann, JT
dc.contributor.authorMayer, F
dc.contributor.authorHöffkes, HG
dc.contributor.authorKoenigsmann, M
dc.contributor.authorArnold, D
dc.contributor.authorKraus, TW
dc.contributor.authorGrimm, K
dc.contributor.authorBerkhoff, S
dc.contributor.authorPost, S
dc.contributor.authorJäger, E
dc.contributor.authorBechstein, W
dc.contributor.authorRonellenfitsch, U
dc.contributor.authorMönig, S
dc.contributor.authorHofheinz, RD
dc.date.accessioned2017-09-25T21:11:51Z
dc.date.available2017-09-25T21:11:51Z
dc.date.issued2017-09-01
dc.description.abstractIMPORTANCE: Surgical resection has a potential benefit for patients with metastatic adenocarcinoma of the stomach and gastroesophageal junction. OBJECTIVE: To evaluate outcome in patients with limited metastatic disease who receive chemotherapy first and proceed to surgical resection. DESIGN, SETTING, AND PARTICIPANTS: The AIO-FLOT3 (Arbeitsgemeinschaft Internistische Onkologie-fluorouracil, leucovorin, oxaliplatin, and docetaxel) trial is a prospective, phase 2 trial of 252 patients with resectable or metastatic gastric or gastroesophageal junction adenocarcinoma. Patients were enrolled from 52 cancer care centers in Germany between February 1, 2009, and January 31, 2010, and stratified to 1 of 3 groups: resectable (arm A), limited metastatic (arm B), or extensive metastatic (arm C). Data cutoff was January 2012, and the analysis was performed in March 2013. INTERVENTIONS: Patients in arm A received 4 preoperative cycles of fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) followed by surgery and 4 postoperative cycles. Patients in arm B received at least 4 cycles of neoadjuvant FLOT and proceeded to surgical resection if restaging (using computed tomography and magnetic resonance imaging) showed a chance of margin-free (R0) resection of the primary tumor and at least a macroscopic complete resection of the metastatic lesions. Patients in arm C were offered FLOT chemotherapy and surgery only if required for palliation. Patients received a median (range) of 8 (1-15) cycles of FLOT. MAIN OUTCOMES AND MEASURES: The primary end point was overall survival. RESULTS: In total, 238 of 252 patients (94.4%) were eligible to participate. The median (range) age of participants was 66 (36-79) years in arm A (n = 51), 63 (28-79) years in arm B (n = 60), and 65 (23-83) years in arm C (n = 127). Patients in arm B (n = 60) had only retroperitoneal lymph node involvement (27 patients [45%]), liver involvement (11 [18.3%]), lung involvement (10 [16.7%]), localized peritoneal involvement (4 [6.7%]), or other (8 [13.3%]) incurable sites. Median overall survival was 22.9 months (95% CI, 16.5 to upper level not achieved) for arm B, compared with 10.7 months (95% CI, 9.1-12.8) for arm C (hazard ratio, 0.37; 95% CI, 0.25-0.55) (P < .001). The response rate for arm B was 60% (complete, 10%; partial, 50%), which is higher than the 43.3% for arm C. In arm B, 36 of 60 patients (60%) proceeded to surgery. The median overall survival was 31.3 months (95% CI, 18.9-upper level not achieved) for patients who proceeded to surgery and 15.9 months (95% CI, 7.1-22.9) for the other patients. CONCLUSIONS AND RELEVANCE: Patients with limited metastatic disease who received neoadjuvant chemotherapy and proceeded to surgery showed a favorable survival. The AIO-FLOT3 trial provides a rationale for further randomized clinical trials. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT00849615.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJAMA Oncol. 2017 Sep 1;3(9):1237-1244.pt_PT
dc.identifier.doi10.1001/jamaoncol.2017.0515pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.26/19006
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.subjectNeoplasias Gástricaspt_PT
dc.subjectQuimioterapia Adjuvantept_PT
dc.subjectTerapia Neoadjuvantept_PT
dc.subjectNeoadjuvant Therapypt_PT
dc.subjectStomach Neoplasmspt_PT
dc.subjectChemotherapy, Adjuvantpt_PT
dc.titleEffect of Neoadjuvant Chemotherapy Followed by Surgical Resection on Survival in Patients With Limited Metastatic Gastric or Gastroesophageal Junction Cancer: The AIO-FLOT3 Trialpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue9pt_PT
oaire.citation.startPage1237-1244pt_PT
oaire.citation.volume3pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
FLOT3 jamaoncology_AlBatran_2017_online publication.pdf
Size:
314.3 KB
Format:
Adobe Portable Document Format
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.85 KB
Format:
Item-specific license agreed upon to submission
Description:
Download

Collections

ICO - Artigos