Treatment for Locally Advanced Gastric and Esophageal Cancers

Locally advanced gastric and esophageal cancers were traditionally treated with surgery alone, however, it is now known that the addition of chemotherapy before and after surgery can improve patient survival by about 15 percent. The most commonly used drug treatment is FLOT, a combination of 5-FU, oxaliplatin, and docetaxel. FLOT chemotherapy treatment before surgery works by downstaging the tumor and allowing for a more successful resection, and additional chemotherapy after surgery can treat any remaining cancer cells.

Transcript:
I'd like to talk to you about treatment options for locally advanced gastric and esophageal cancers. By locally advanced, I mean that the tumor is still within the primary organ, but it has caused some invasion into the stomach wall or the esophageal wall and/or possibly some lymph node invasion. Lymph nodes are the way by which cancer travels to other parts of the body. For a long time, the only way to cure gastric and esophageal cancers is by surgery alone. However, we've learned that adding chemotherapy to surgery helps with treatment outcomes. By treatment outcomes, I mean like survival.

By giving chemotherapy before and afterwards, we've learned that survival can improve by about 15 percent. By giving chemotherapy before surgery, what that does, it downstages the tumor. It allows the surgeon to be as successful as possible when he or she goes into the OR and resects your stomach tumor. By giving chemotherapy after surgery, what that does is that, if there's any residual cancer still left over in the body, which is a big issue in stomach cancer, by giving chemotherapy afterwards, we hope that the chemotherapy will be able to eliminate any residual microscopic tumor cells that are still remaining in the body.

The current regimen that we use is something called FLOT, F-L-O-T. This is a combination of 5-FU, oxaliplatin, and docetaxel. This is given four times before surgery and four times after surgery. When we give it before surgery, it's given every two weeks. It's a tough regimen, and so I would advise that patients take a white blood cell booster called Neupogen or Neulasta. This will help you to continue chemotherapy according to schedule.