# Real-world comparison between neoadjuvant FLOT therapy and DCF therapy for resectable esophagogastric junction adenocarcinoma

## TL;DR

This study compares FLOT and DCF therapies for treating esophagogastric junction cancer, finding FLOT to be more effective and safer in the short term.

## Contribution

The study provides real-world evidence comparing FLOT and DCF therapies for EGJ-AC in a Japanese context.

## Key findings

- FLOT therapy showed a higher pathologic complete response rate compared to DCF therapy.
- FLOT therapy had a better 1-year disease-free survival rate than DCF therapy.
- FLOT therapy was associated with fewer cases of febrile neutropenia than DCF therapy.

## Abstract

In Western countries, the standard perioperative treatment for resectable locally advanced esophagogastric junction adenocarcinoma (EGJ-AC) is 5-fluorouracil, oxaliplatin, and docetaxel (FLOT) therapy based on the results of the FLOT4 and ESOPEC trials. On the other hand, there was little evidence based on optimal perioperative treatment for resectable locally advanced EGJ-AC in Japan. Our previous report showed that neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy demonstrated modest efficacy for resectable locally advanced EGJ-AC. Therefore, we compared neoadjuvant DCF to FLOT therapy in terms of efficacy and safety in this study.

We retrospectively analyzed the data of patients who received DCF or FLOT therapy for resectable EGJ-AC between 2015 and 2024 in our hospital. We assessed the R0 resection rate, histopathological response, disease-free survival (DFS), overall survival, and adverse events.

Thirty-two patients in the DCF therapy group and 20 patients in the FLOT therapy group were analyzed. The patients’ characteristics in the DCF group and FLOT group were as follows: median age, 63/59 years; ECOG PS 0, 66%/85%, respectively. The pCR rate was numerically higher in the FLOT group (20%) compared with the DCF group (3%) (p = 0.07). Similarly, the 1-year DFS rate was higher in the FLOT group (93%) than in the DCF group (68%) (p = 0.02), although this difference did not remain statistically significant after adjustment for baseline factors. Febrile neutropenia was significantly lower in the FLOT group (0%) than in the DCF group (12.5%).

Neoadjuvant FLOT therapy is well-tolerated and has comparable short-term efficacy to DCF therapy.