Neoadjuvant PD-1 inhibitor combined with FLOT versus SOX for locally advanced gastric cancer: a retrospective cohort study - PubMed

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Study compares neoadjuvant PD-1 inhibitor combined with SOX versus FLOT for locally advanced gastric cancer (LAGC) and gastroesophageal junction (EGJ) adenocarcinoma.
Primary endpoint was pathological complete response (pCR), with secondary endpoints including major pathological response (MPR), radiologic response, perioperative outcomes, and survival.
247 patients were enrolled (141 PD-1+SOX, 106 PD-1+FLOT) with comparable baseline characteristics.
No significant differences in radiologic outcomes (ORR: 70.92% vs 66.98%, p=0.507; DCR: 87.23% vs 85.85%, p=0.752) or pathological responses (pCR: 20.57% vs 16.98%, p=0.477; MPR: 37.59% vs 31.13%, p=0.292).
Treatment-related adverse events were higher in the PD-1+FLOT group (75.47% any-grade, 26.42% grade ≥3) compared to PD-1+SOX (67.38% any-grade, 19.15% grade ≥3).
Operative time and blood loss were higher in the PD-1+FLOT group, but postoperative complication rates were comparable.
No significant differences in overall survival (OS) or recurrence-free survival (RFS) between the two groups.
Non-MPR was identified as an independent risk factor for both OS and RFS.
Conclusion: PD-1+SOX and PD-1+FLOT showed comparable efficacy and safety, with PD-1+SOX associated with less operative burden.

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