• Which chemotherapy routine is better for patients having gastric cancer surgery? This study compared two options. Routine A (ECF/ECX) was epirubicin, cisplatin and either fluorouracil or capecitabine. Routine B (FLOT) was docetaxel, oxaliplatin, leucovorin and fluorouracil. Overall, the FLOT routine was better for this patient group.



  • Germany


  • 2017, Journal of Clinical Oncology

Impact Factor (IF):

  • 24.008

This study compared two different chemotherapy routines. Both were given before and after gastric cancer resection surgery. The researchers were measuring pathological complete resection (PCR). A surgery which achieves PCR means that all of the cancer cells were successfully cut out. So, they wanted to know which medicines would shrink the tumor so that the surgeon could best achieve PCR.

300 patients with cancer of the stomach or gastroesophageal junction were randomly assigned to receive one of two drug combinations:

  1. ECF/ECX Group:
    1. Epirubicin, Cisplatin + either Fluorouracil/Capecitabine
    2. 3 cycles lasting 3 weeks each (9 weeks total)
    3. Before and after surgery
  2. FLOT Group:
    1. Docetaxel, Oxaliplatin, Leucovorin + Fluorouracil
    2. 4 cycles lasting 2 weeks each (8 weeks total)
    3. Before and after surgery

What do these drugs do?

  • Epirubicin: this drug kills cancer cells by breaking up the structure of their genetic material
  • Cisplatin: this drug stops cancer from making more cells.
  • Fluorouracil: this drug also stops cancer cells from dividing properly. It may have the name ADRUCIL in Canada.
  • Capecitabine: this drug also stops cancer cells from dividing properly
  • Docetaxel: disrupts the cell’s internal support system so it cannot divide properly.
  • Oxaliplatin: this drug stops cancer cell genetic material from dividing properly.
  • Leucovorin: enhances the anti-cancer effects of 5-FU.

Surgery: the area of the stomach or esophagus with the tumor was removed. Also, a lymphadenectomy was performed to remove a number of lymph nodes according to the location of the tumor.

Results: The researchers found that surgery in FLOT Group patients was able to take out more of the cancer. That means surgery was more likely to achieve pathological complete resection in this group. Also, patients in the FLOT group showed better compliance. This means they were more likely to take their prescribed medicine for all chemotherapy cycles than the ECF/ECX group was. Finally, FLOT patients had fewer side effects.

Only 25% of FLOT patients had at least 1 severe adverse effect, while 40% of the ECF/ECX group did.

Patients with certain types of tumors (intestinal tumors) benefitted from the FLOT routine more than others (diffuse tumors) did. So, the researchers found that the FLOT chemotherapy routine can be a helpful option, especially for removing certain tumor types.

Related readings:

  • christie.nhs.uk/media/6364/1225.pdf
    • This website provides an informative outline for what patients prescribed the FLOT chemotherapy routine can expect. It is a resource from the UK.


  • Al-Batran, Salah-Eddin, et al. “Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (FLOT4-AIO): A multicenter, randomized phase 3 trial.” (2017): 4004-4004. Available from: doi: 10.1200/JCO.2017.35.15_suppl.4004