Evidence map›Paper›PMID 30982686›Full record

Trial reportLancet (London, England)2019

Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial.

Salah-Eddin Al-Batran, Nils Homann, Claudia Pauligk, Thorsten O Goetze, Johannes Meiler, Stefan Kasper, Hans-Georg Kopp, Frank Mayer, Georg Martin Haag, Kim Luley and 48 more

8 registry-linked trialsAbstract readClinical Trial, Phase IIClinical Trial, Phase IIIComparative Study
PubMed Publisher
In one paragraph

Trial report in Lancet (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 8 registered trials, which are not on this map. Cited by 1,475 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1,475citing papers in PubMed, 11 pooled it
185.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03620643 phase2completednot on this map

Phase II Study of ROS1 Targeting With Crizotinib in Advanced E-cadherin Negative, ER Positive Lobular Breast Cancer, Diffuse Gastric Cancer, Triple Negative Lobular Breast Cancer or CDH1-mutated Solid Tumours

TypeinterventionalSponsorRoyal Marsden NHS Foundation TrustRan2019 to 2024Enrolled33ConditionsLobular Breast Carcinoma, Gastric Cancer, Triple Negative Breast Cancer, CDH1 Gene MutationArmsCrizotinib Oral Capsule [Xalkori], Fulvestrant 50 MG/ML Prefilled Syringe [Faslodex or generic]
NCT04999332 phase2unknown statusnot on this mapstarted 2021, after this paper: background citation

A Phase II Trial of Perioperative Chemotherapy With Leucovorin, Oxaliplatin, Docetaxel and S-1 (LOTS) For Patients With Locally Advanced Gastric or Gastroesophageal Junction Adenocarcinoma

TypeinterventionalSponsorNational Cheng-Kung University HospitalRan2021 to 2025Enrolled58ConditionsGastric Cancer, Gastric Adenocarcinoma, Effects of Chemotherapy, Toxicity Due to ChemotherapyArmsleucovorin, oxaliplatin, docetaxel, S-1
NCT05346874 phase2unknown statusnot on this mapstarted 2022, after this paper: background citation

Neoadjuvant Transcatheter Arterial Chemoinfusion and Embolism (TACiE) for Patients With Locally Advanced Adenocarcinoma of Stomach and Gastroesophageal Junction: a Prospective, Phase 2, Single Arm Trial.

TypeinterventionalSponsorShanghai Zhongshan HospitalRan2022 to 2025Enrolled37ConditionsGastric CancerArmsOxaliplatin, Teysuno, Transarterial chemoembolization (TACE)
NCT05396326 phase1unknown statusnot on this mapstarted 2022, after this paper: background citation

Neoadjuvant Transcatheter Arterial Chemoinfusion and Embolism (TACiE) for Patients With Locally Advanced Adenocarcinoma of Stomach and Gastroesophageal Junction: a Pilot Study

TypeinterventionalSponsorShanghai Zhongshan HospitalRan2022 to 2025Enrolled20ConditionsGastric CancerArmsOxaliplatin, Teysuno, Transarterial arterial chemoinfusion and embolism (TACiE)
NCT05687617 phase2terminatednot on this mapstarted 2022, after this paper: background citation

Diagnostic Value of Intraoperative Near-infrared Imaging With Indocyanine Green for Detection of Peritoneal Metastases During Staging Laparoscopy for Gastric Adenocarcinoma: a Prospective, Multicentric Study.

TypeinterventionalSponsorLaval UniversityRan2022 to 2024Enrolled11ConditionsGastric Cancer, Gastric Adenocarcinoma, Peritoneal Carcinomatosis, Peritoneal MetastasesArmsIndocyanine green
NCT06469060 phase2not yet recruitingnot on this mapstarted 2024, after this paper: background citation

Tislelizumab Combined With Chemotherapy as Neoadjuvant Regimen for AdenoCarcinoma of the Esophagogastric Junction: a Single-arm, Phase II Clinical Trial (TRACE)

TypeinterventionalSponsorShanghai Chest HospitalRan2024 to 2027Enrolled34ConditionsEsophageal CancerArmsneoadjuvant anti-PD-1 with DOC chemotherapy
NCT07565857 nanot yet recruitingnot on this mapstarted 2026, after this paper: background citation

SIGNAL GEC-101: Signatera-Guided De-escalation of Adjuvant Therapy in Resectable Stage II-IVa Gastric/Gastric-Esophageal Cancer

TypeinterventionalSponsorNatera, Inc.Ran2026 to 2034Enrolled1,000ConditionsGastric-Esophageal CancerArmsSignatera Genome ultra-sensitive ctDNA blood test
NCT07692477 not yet recruitingnot on this mapstarted 2026, after this paper: background citation

Molecular Characterization of Tumor-Microenvironment Interactions to Predict Drug Resistance to Perioperative Treatment in Patients With Gastric and Gastroesophageal Junction Adenocarcinoma

TypeobservationalSponsorAzienda Ospedaliera Specializzata in Gastroenterologia Saverio de BellisRan2026 to 2028Enrolled250ConditionsGastric Adenocarcinoma, Gastroesophageal Junction Adenocarcinoma (Siewert II-III)
3 · Its place in the literature

Who cites it

1,475 citing papers in PubMed, 11 syntheses or guidelines pooled it, 2,483 citations in OpenAlex.

  1. Pooled it
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  5. Japanese gastric cancer treatment guidelines 2025 (7th edition).Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2026
    Guideline
  6. Pooled it
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  12. Trial
  13. Preoperative chemotherapy with docetaxel, oxaliplatin, and S-1 for gastric cancer with extensive lymph node metastasis: 3-year follow-up results from JCOG1704.Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2026
    Trial
  14. Trial
  15. A phase II study of neoadjuvant chemotherapy with docetaxel, cisplatin, and S-1 followed by gastrectomy for type 4 or large type 3 gastric cancer (OGSG 1402).Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association · 2026
    Trial
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1,415 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

58 authors at 20 institutions in 2 countries.

Salah-Eddin Al-BatranInstitute of Clinical Cancer Research, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany; IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany. Electronic address: albatran@ikf-khnw.de.
Nils HomannKlinikum Wolfsburg, Wolfsburg, Germany.
Claudia PauligkInstitute of Clinical Cancer Research, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany; IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany.
Thorsten O GoetzeInstitute of Clinical Cancer Research, Krankenhaus Nordwest, UCT-University Cancer Center, Frankfurt, Germany; IKF Klinische Krebsforschung GmbH am Krankenhaus Nordwest, Frankfurt, Germany.
Johannes MeilerWest German Cancer Center, Department of Medical Oncology, University Duisburg-Essen, Essen, Germany.
Stefan KasperWest German Cancer Center, Department of Medical Oncology, University Duisburg-Essen, Essen, Germany.
Hans-Georg KoppRobert Bosch Centrum für Tumorerkrankungen (RBCT), Stuttgart, Germany.
Frank MayerUniversitätsklinikum der Eberhard-Karls-Universität, Medizinische Klinik II, Abt. Onkologie, Hämatologie, Immunologie, Rheumatologie, Pneumologie, Tübingen, Germany.
Georg Martin HaagNationales Centrum für Tumorerkrankungen, Abteilung Medizinische Onkologie, Universitätsklinikum Heidelberg, Heidelberg, Germany.
Kim LuleyKlinik für Hämatologie und Onkologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany.
Udo LindigUniversitätsklinikum Jena, Klinik für Innere Medizin II, Abt. Hämatologie und Onkologie, Jena, Germany.
Wolff SchmiegelRuhr-University Bochum, Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany; Department of Gastroenterology and Hepatology, Ruhr-University Bochum, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil gGmbH, Bochum, Germany.
Michael PohlRuhr-University Bochum, Department of Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum GmbH, Bochum, Germany.
Jan StoehlmacherUniversitätsklinikum Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden, Germany.
Gunnar FolprechtUniversitätsklinikum Carl Gustav Carus, Medizinische Klinik und Poliklinik I, Dresden, Germany.
Stephan ProbstKlinikum Bielefeld, Klinik für Hämatologie und Onkologie, Bielefeld, Germany.
Nicole PrasnikarAsklepios Klinik Barmbek, Hämatologie, Onkologie und Palliativmedizin, Hamburg, Germany.
Wolfgang FischbachKlinikum Aschaffenburg, Medizinische Klinik II, Gastroenterologie und Onkologie, Aschaffenburg, Germany.
Rolf MahlbergKlinikum Mutterhaus der Borromäerinnen, Med. Klinik I, Trier, Germany.
Jörg TrojanUniversitätsklinikum Frankfurt, Goethe-Universität, Med. Klinik I, Frankfurt, Germany.
Michael KoenigsmannMediProjekt, Gesellschaft für Medizinstatistik und Projektentwicklung, Hannover, Germany.
Uwe M MartensSLK-Kliniken GmbH, Cancer Center Heilbronn-Franken, Klinik für Innere Medizin III, Heilbronn, Germany.
Peter Thuss-PatienceCharité - Universitätsmedizin Berlin, Med. Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Berlin, Germany.
Matthias EggerOrtenau Klinikum Lahr, Medizinische Klinik, Gastroenterologie und Onkologie, Sektion Hämatologie und Onkologie, Lahr, Germany.
Andreas BlockUniversitätsklinikum Hamburg-Eppendorf, UCCH, II. Medizinische Klinik und Poliklinik (Onkologie, Hämatologie, KMT mit Sektion Pneumologie), Hamburg, Germany.
Volker HeinemannMedizinische Klinik und Poliklinik III, Klinikum der Universität München, Campus Grosshadern, Münich, Germany.
Gerald IllerhausKlinik für Hämatologie, Onkologie und Palliativmedizin, Klinikum Stuttgart, Stuttgart, Germany.
Markus MoehlerJohannes-Gutenberg Universität Mainz, I. Med. Klinik und Poliklinik, Mainz, Germany.
Michael SchenkKrankenhaus Barmherzige Brüder Regensburg, Klinik für Onkologie und Hämatologie, Regensburg, Germany.
Frank KullmannKlinikum Weiden, Med. Klinik I, Weiden, Germany.
Dirk M BehringerAugusta-Krankenanstalt Bochum, Klinik für Hämatologie und Onkologie, Bochum, Germany.
Michael HeikeKlinikum Dortmund gGmbH, Medizinische Klinik, Gastroenterologie, Hämatologie/Onkologie, Endokrinologie, Dortmund, Germany.
Daniel PinkHelios Klinikum Bad Saarow, Klinik für Hämatologie, Onkologie und Palliativmedizin, Bad Saarow, Germany; Universitätsmedizin Greifswald, Klinik und Poliklinik für Innere Medizin C - Hämatologie und Onkologie und Transplantationszentrum, Greifswald, Germany.
Christian TeschendorfSt.- Josefs- Hospital, Klinik für Innere Medizin, Dortmund, Germany.
Carmen LöhrHorst-Schmidt-Kliniken, Innere Medizin 2, Wiesbaden, Germany.
Helga BernhardKlinikum Darmstadt, Med. Klinik V, Hämatologie und Onkologie, Darmstadt, Germany.
Gunter SchuchHämatologisch-Onkologische Praxis Altona (HOPA), Hamburg, Germany.
Volker RethwischKlinikum Dortmund gGmbH, Medizinische Klinik, Gastroenterologie, Hämatologie/Onkologie, Endokrinologie, Dortmund, Germany.
Ludwig Fischer von WeikersthalHämatologie/Internistische Onkologie, MVZ Gesundheitszentrum St Marien GmbH, Amberg, Germany.
Jörg T HartmannCatholic Hospital Consortium Eastern Westphalia, Franziskus Hospital Bielefeld, Klinik für Innere Medizin II, Hämatologie, Internistische Onkologie, Immunologie, Bielefeld, Germany.
Michael KnebaKlinik für Innere Medizin II - Hämatologie und Onkologie, University Clinics Schleswig Holstein- Campus Kiel, Kiel, Germany.
Severin DaumKlinik für Gastroenterologie, Infektiologie und Rheumatologie, Berlin, Germany.
Karsten SchulmannMVZ Arnsberg, Praxis für Hämatologie und Onkologie, Arnsberg, Germany.
Jörg WenigerGemeinschaftspraxis Dr. Weniger /Dr. Bittrich/Dr. Schütze, Erfurt, Germany.
Sebastian BelleII. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany.
Timo GaiserInstitut für Pathologie, Universitätsmedizin Mannheim, Mannheim, Germany.
Fuat S OduncuMedizinische Klinik und Poliklinik III, Klinikum der Universität München, München, Germany.
Martina GüntnerTrium Analysis Online, München, Germany.
Wael HozaeelMVZ Onkologie GmbH, Am Marienhospital, Hagen, Germany.
Alexander ReichartKlinik für Onkologie und Hämatologie, Krankenhaus Nordwest, UCT- University Cancer Center, Frankfurt am Main, Frankfurt, Germany.
Elke JägerKlinik für Onkologie und Hämatologie, Krankenhaus Nordwest, UCT- University Cancer Center, Frankfurt am Main, Frankfurt, Germany.
Thomas KrausKlinik für Allgemein-, Viszeral- und Minimal Invasive Chirurgie, Krankenhaus Nordwest, UCT- University Cancer Center, Frankfurt, Germany.
Stefan MönigService de Chirurgie viscérale, Hôpitaux Universitaires de Genève, Genève, Switzerland.
Wolf O BechsteinFrankfurt University Hospital and Clinics, Department of General and Visceral Surgery, Frankfurt, Germany.
Martin SchulerWest German Cancer Center, Department of Medical Oncology, University Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), Partner site University Hospital Essen Essen, Germany.
Harald SchmalenbergUniversitätsklinikum Jena, Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Jena, Germany.
Ralf D HofheinzTagestherapiezentrum am ITM, III. Medizinische Klinik, Universitätsmedizin Mannheim, Mannheim, Germany.
FLOT4-AIO Investigators
Krankenhaus Nordwest · DEGoethe University Frankfurt · DEHeidelberg University · DEJena University Hospital · DEKlinikum Dortmund · DEKlinik und Poliklinik für Psychotherapie und Psychosomatik · DELMU Klinikum · DEUniversity Hospital Frankfurt · DEUniversity of Duisburg-Essen · DEAsklepios Klinik Barmbek · DEAugusta-Kranken-Anstalt · DECharité - Universitätsmedizin Berlin · DEEssen University Hospital · DEFrancis Hospital · DEFraunhofer Project Centre Wolfsburg · DEHelios Dr. Horst Schmidt Kliniken Wiesbaden · DEHôpital Beau-Séjour · CHInstitute of Clinical Cancer Research · DEJohannes Gutenberg University Mainz · DEKlinikum Arnsberg · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDocetaxel-based chemotherapy is effective in metastatic gastric and gastro-oesophageal junction adenocarcinoma. This study reports on the safety and efficacy of the docetaxel-based triplet FLOT (fluorouracil plus leucovorin, oxaliplatin and docetaxel) as a perioperative therapy for patients with locally advanced, resectable tumours.

methodsIn this controlled, open-label, phase 2/3 trial, we randomly assigned 716 patients with histologically-confirmed advanced clinical stage cT2 or higher or nodal positive stage (cN+), or both, resectable tumours, with no evidence of distant metastases, via central interactive web-based-response system, to receive either three pre-operative and three postoperative 3-week cycles of 50 mg/m

findingsBetween Aug 8, 2010, and Feb 10, 2015, 716 patients were randomly assigned to treatment in 38 German hospitals or with practice-based oncologists. 360 patients were assigned to ECF/ECX and 356 patients to FLOT. Overall survival was increased in the FLOT group compared with the ECF/ECX group (hazard ratio [HR] 0·77; 95% confidence interval [CI; 0.63 to 0·94]; median overall survival, 50 months [38·33 to not reached] vs 35 months [27·35 to 46·26]). The number of patients with related serious adverse events (including those occurring during hospital stay for surgery) was similar in the two groups (96 [27%] in the ECF/ECX group vs 97 [27%] in the FLOT group), as was the number of toxic deaths (two [<1%] in both groups). Hospitalisation for toxicity occurred in 94 patients (26%) in the ECF/ECX group and 89 patients (25%) in the FLOT group.

interpretationIn locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma, perioperative FLOT improved overall survival compared with perioperative ECF/ECX.

fundingThe German Cancer Aid (Deutsche Krebshilfe), Sanofi-Aventis, Chugai, and Stiftung Leben mit Krebs Foundation.

Indexed as

AdenocarcinomaAdministration, OralAdultAgedAged, 80 and overAntineoplastic Combined Chemotherapy ProtocolsCapecitabineCisplatinDigestive System Surgical ProceduresDisease-Free SurvivalDocetaxelEsophagogastric JunctionFemaleFluorouracilHumansLeucovorinCapecitabineCisplatinDocetaxelFluorouracilLeucovorinOxaliplatin

Identifiers

PMID30982686
OpenAlexW2938774982

What OpenQuestion holds

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Registered trials

and 2 more above

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.