Helping patients with gastroesophageal cancer avoid unnecessary chemo
31 March 2025
The SPACE-FLOT study involved 43 hospitals - including Peter Mac - across 12 countries and tracked almost 1,900 patients who received the current standard of care “FLOT” chemotherapy before and after surgery to remove their cancer.
This chemotherapy regimen is designed to shrink a tumour before surgery, and afterwards kill any cancer cells left behind, however up to 50% of patients feel too unwell to complete all the recommended doses.
Associate Professor David Liu says the trial results, just published in the British Journal of Surgery, provide clinicians the evidence to help personalise this chemotherapy treatment to maximise it efficacy and reduce harm for patients.
“This trial shows there are two groups of patients who may not derive the intended benefit of FLOT chemotherapy however they still receive the risk of significant chemotherapy-related toxicities,” says Associate Professor Liu, an oesophago-gastric cancer surgeon and study-lead at Peter Mac.
“This can result in unnecessary harm, particularly at a time when these patients are recovering from radical surgery.”
Patients in the trial were split into three groups – those who had a minimal, a partial or a complete response to FLOT chemotherapy before surgery. A patients’ initial response was highly predictive of their response to FLOT after surgery.
“Patients who had a minimal response initially did not benefit from further FLOT after surgery, and similarly those who had a complete response also did not derive any additional benefit,” Associate Professor Liu says.
“Only patients who had a partial response to FLOT before surgery should repeat this treatment after surgery as the data shows this can increase both their disease-free, and overall, survival.”
The chemotherapy regimen “FLOT” involves a combination of Fluorouracil, Leucovorin, Oxaliplatin and Taxotere (docetaxel).
The paper is titled “Pathological response guides adjuvant FLOT chemotherapy in surgically resected gastroesophageal cancer (SPACE-FLOT): An international cohort study” and you can access the paper here.
Each year more than 1,700 Australians are diagnosed with gastroesophageal cancer, which has a five-year survival rate of less than 25%.