Do Gastric and Esophageal Cancer Patients Benefit From More Chemotherapy Before Surgery?
Traditionally, patients with gastric cancer and esophageal cancer receive a combination chemotherapy regimen called FLOT. It consists of four different types of chemotherapy designed to shrink tumors, improve survival rates and reduce disease recurrence.
Typically, treatment consists of four cycles of FLOT before surgery, followed by four additional cycles post-surgery.
Previous studies have shown that less than half of patients complete the full eight-cycle regimen of the treatment.
Happening now at #SSO2026: Victor Gazivoda, MD, presents a retrospective analysis of nonmetastatic gastroesophageal adenocarcinoma showing that ≥6 preoperative chemotherapy cycles improved treatment completion without increasing surgical morbidity and achieved comparable… pic.twitter.com/sSE8fDIsbV
— Moffitt Cancer Center (@MoffittNews) March 5, 2026
With a team of colleagues, Victor Gazivoda, MD, a surgical oncology fellow at Moffitt Cancer Center, conducted a study to assess if patients benefit from receiving more chemotherapy before undergoing surgery.
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33
Patients received four or fewer preoperative FLOT cycles
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63
Patients received six or more preoperative FLOT cycles
Of the 96 patients in the study, 33 received four or fewer preoperative FLOT cycles, whereas 63 received six or more.
Gazivoda breaks down the study’s results.
What was the outcome of this study?
We did not find a difference in overall survival or disease-free survival, but we did see that pathologic complete response was doubled in patients who received more upfront chemotherapy. Additionally, the patients who received more preoperative chemotherapy had a higher treatment completion rate.
What could this mean for treatment in the future?
Giving more upfront chemotherapy promotes completion of the full chemotherapy regimen and demonstrates double the pathologic complete response rate without worsening post-surgical outcomes.
What are the next steps now that this study is complete?
Ideally, we would like to enroll more patients in a larger (well powered) prospective study with a longer follow up to determine whether completion of the full chemotherapy regimen with more upfront therapy impacts oncologic outcomes.
