An international clinical study, SPACE-FLOT, led by Austin Health clinicians has found a way to tailor further intensive rounds of chemotherapy after surgery for patients with gastroesophageal cancer.
The SPACE-FLOT study, published in the British Journal of Surgery, involved 43 hospitals, including Austin Health, and was spread across 12 countries. It followed almost 1,900 patients who received the current standard of care, FLOT chemotherapy regimen, before and after their surgery.
FLOT involves a combination of chemotherapies - Fluorouracil, Leucovorin, Oxaliplatin and the Taxane-class chemotherapy drug docetaxel. FLOT chemotherapy is designed to shrink a tumour before surgery and afterwards eliminate any cancer cells left behind. However, it is also associated with significant side effects with up to 50 per cent of patients unable to complete all the recommended doses.
Associate Professor David Liu, an oesophago-gastric cancer surgeon at Austin Health and study-lead, is excited by the trial’s findings which point to a way to tailor and reduce the burden of treatment for patients with gastroesophageal cancers.
“This trial has shown there are two groups of patients who may not derive the intended benefit of FLOT chemotherapy, however, these patients still receive the risk of significant chemotherapy-related toxicities resulting in unnecessary harm, particularly at a time when they are recovering from radical surgery,” says A/Prof Liu.
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 patient’s initial response was highly predictive of their response to FLOT after surgery.
“Only patients who had a partial response to FLOT before surgery benefit from repeating this treatment after surgery as the data shows this can improve their overall chances of survival. Patients who had a minimal response initially did not benefit from further FLOT after surgery, and similarly those who had a complete response, who also did not derive any additional benefit,” explains A/Prof Liu.
Each year more than 1,700 Australians are diagnosed with gastroesophageal cancer, which has a five-year survival rate of less than 25 per cent. The SPACE-FLOT study provides clinicians the evidence to help personalise chemotherapy treatment for patients with gastroesophageal cancer, thereby maximising its treatment efficacy and reducing harm.