FLOT vs DOS neoadjuvant chemotherapy in locally advanced gastric cancer: propensity score analysis.

[BACKGROUND] The safety and efficacy of neoadjuvant FLOT (Fluorouracil, Leucovorin, Oxaliplatin, Docetaxel) and DOS (Docetaxel, Oxaliplatin, S-1) regimens for locally advanced gastric cancer (LAGC) have not been compared.

[METHODS] Patients with histologically confirmed LAGC (stage ≥ cT3 or cN + , no metastasis) treated between 2017-2021 were retrospectively included and propensity-matched into FLOT (4 cycles, n = 72) and DOS (3 cycles, n = 72) groups. Outcomes included RECIST response, grade 3/4 adverse events, surgical/pathological results, and R0 resection rates, and long-term survival (overall survival [OS] and progression-free survival [PFS]).

[RESULTS] RECIST response rates were 41.7% (FLOT) vs. 47.2% (DOS); R0 resection rates were 63.9% vs. 72.2%. No significant differences were observed in operative time, blood loss, hospital stay, histopathological regression (TRG1a: 2.8% vs. 8.3%; TRG1b: 13.9% vs. 16.7%), postoperative morbidity (29.8% vs. 24.5%), or grade 3/4 toxicity (20.8% vs. 13.9%). The 5-year OS rates were 42.7% and 50.4% (p = 0.652), and the PFS rates were 33.7% and 41.4% (p = 0.548) for the FLOT and DOS groups, respectively.

[CONCLUSION] DOS demonstrated no significant but favorable feasibility, safety, and efficacy compared to FLOT in LAGC. Shorter hospital stay with DOS may enhance patient comfort and reduce healthcare burden.