Effect of peri-operative chemotherapy regimen on survival in the treatment of locally advanced oesophago-gastric adenocarcinoma – A comparison of the FLOT and ‘MAGIC’ regimens

• Published in: European journal of cancer (1990) 2022-03, Vol.163, p.180-188
• Main Authors: Moore, Jonathan L., Kumar, Sacheen, Santaolalla, Aida, Patel, Pranav H., Kapiris, Matthaios, Van Hemelrijck, Mieke, Maisey, Nick, Hill, Mark, Lagergren, Jesper, Gossage, James A., Kelly, Mark, Chaudry, Asif, Allum, William H., Baker, Cara R., Cunningham, David, Davies, Andrew R., Jacques, A., Griffin, N., Goh, V., Ngan, S., Owczarczyk, K., Lumsden, A., Qureshi, A., Deere, H., Green, M., Chang, F., Mahadeva, U., Gill-Barman, B., George, S., Ong, M., Waters, J., Cominos, M., Sevitt, T., Hynes, O., Tham, G., Bott, R.K., Dunn, J.M., Zeki, S.S.
• Format: Article
• Language: English
• Subjects: 5-Fluorouracil; Adenocarcinoma; Adenocarcinoma - drug therapy; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adverse events; Antineoplastic combined chemotherapy protocols; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Cancer; Chemotherapy; Cisplatin; Cohort Studies; Complications; Confidence intervals; Epirubicin; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagogastric Junction - pathology; Esophagogastric Junction - surgery; Esophagus; Fluorouracil; Gastric cancer; Gastric neoplasms; Health services; Humans; Medical research; Medicin och hälsovetenskap; Oesophageal neoplasms; Oxaliplatin; Patients; Statistical analysis; Stomach Neoplasms - drug therapy; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgical oncology; Survival; Survival analysis; Tumors
• ISSN: 0959-8049; 1879-0852; 1879-0852
• DOI: 10.1016/j.ejca.2021.12.021

Peri-operative chemotherapy improves survival in patients with locally advanced oesophago-gastric adenocarcinoma. Two regimens with proven survival benefits are epirubicin, cisplatin plus capecitabine or fluorouracil (Medical Research Council Adjuvant Gastric Infusional Chemotherapy, MAGIC) and fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT). This study aimed to compare the effect of these regimens on survival (primary aim) and pathological response, surgical complications, adverse events and chemotherapy completion rates. Cohort study including 946 patients treated with FLOT (n = 257) or MAGIC (n = 689) who underwent surgical resection for oesophageal (n = 743) or gastric (n = 203) adenocarcinoma between 2002 and 2021 at St Thomas’ Hospital or The Royal Marsden Hospital, London, UK. Survival analysis was performed using multivariable Cox regression, providing hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, sex, clinical T-stage, clinical N-stage, tumour grade and presence of signet ring cells. Patients treated with FLOT had better overall survival (HR = 0.69, 95% CI 0.50–0.94) and disease-free survival (HR = 0.75, 95% CI 0.58–0.98) than MAGIC. Patients treated with FLOT were more likely to have a complete pathological response (9.5% FLOT versus 5.5% MAGIC, p = 0.027) and were less likely to have a positive resection margin (19.1% FLOT versus 32.2% MAGIC, p