Would you consider giving FLOT entirely in the neoadjuvant setting for resectable gastric cancer?
If so, how many cycles would you give? Both the MAGIC and FLOT trials showed difficulty with administering adjuvant chemotherapy.
Answer from: Medical Oncologist at Academic Institution
I do favor trying to give all the chemotherapy upfront, including FLOT. This builds upon compelling data from other GI cancers, like rectal cancer and pancreas adenocarcinoma, and the evidence that there has never been a trial (to my knowledge) that showed worse outcomes with total upfront chemo, vs...
Answer from: Medical Oncologist at Academic Institution
I would only consider neoadjuvant treatment for MSI-H patients using immunotherapy with chemotherapy for resectable gastric cancer, based on the data from DANTE and NEONIPIGA study. For patients with MSS status, I would favor peri-operative chemotherapy.