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Durvalumab Plus FLOT Ups Survival in Early Upper-GI Cancer
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A new treatment regimen combining the immunotherapy drug durvalumab with the FLOT chemotherapy protocol has demonstrated a significant advancement in overall survival for patients with resectable, locally advanced upper gastrointestinal (GI) cancer. Results from the pivotal MATTERHORN trial, presented at the European Society for Medical oncology (ESMO) Congress 2023, are prompting a potential shift in the standard of care for this challenging cancer type.
The MATTERHORN Trial: A Breakthrough in Upper-GI Cancer Treatment
The MATTERHORN trial, a randomized, phase 3 study, involved 385 patients with HER2-negative, resectable locally advanced gastric or gastroesophageal adenocarcinoma. Participants received either four cycles of perioperative durvalumab plus FLOT (fluorouracil, leucovorin, oxaliplatin, docetaxel) or four cycles of perioperative FLOT alone. The primary endpoint was progression-free survival (PFS), but overall survival (OS) has now emerged as a key indicator of the treatment’s benefit.
Key Findings and Data
The addition of durvalumab to FLOT resulted in a statistically significant and clinically meaningful improvement in overall survival. median overall survival was 22.4 months with durvalumab plus FLOT compared to 16.8 months with FLOT alone, representing a hazard ratio of 0.69 (95% confidence interval, 0.56-0.84; p = 0.0003).These are clinically meaningful results that could change practice
,stated Dr. Charles Kelly,lead investigator of the MATTERHORN trial,during the ESMO presentation.
| Endpoint | Durvalumab + FLOT | FLOT Alone |
|---|---|---|
| Median OS (months) | 22.4 | 16.8 |
| Hazard Ratio (HR) | 0.69 | – |
| P-value | 0.0003 | – |
| Patients Enrolled | 385 | – |
Did You Know?
Upper GI cancers, including gastric and gastroesophageal cancers, are often diagnosed at a late stage, making treatment particularly challenging.
Understanding FLOT and Durvalumab
FLOT is a well-established chemotherapy regimen for resectable gastric and gastroesophageal cancer. Durvalumab is an anti-PD-L1 immunotherapy drug that works by helping the immune system recognize and attack cancer cells. Combining these approaches aims to maximize treatment efficacy by targeting the cancer through multiple pathways.
Safety profile
While the addition of durvalumab was associated with increased adverse events, including grade 3 or 4 events in 48% of patients compared to 34% with FLOT alone, these were generally manageable. the most common grade 3 or 4 adverse events included neutropenia, anemia, and fatigue.
Pro tip: Discuss potential side effects and management strategies with your oncologist to ensure the best possible treatment experience.
Implications for future Treatment
the MATTERHORN trial results strongly suggest that perioperative durvalumab plus FLOT should be considered as a new standard of care for patients with resectable, locally advanced upper-GI cancer. Further research is ongoing to identify biomarkers that may predict which patients are most likely to benefit from this treatment combination.
“These results are practice-changing and will likely lead to a significant improvement in outcomes for patients with this devastating disease.” – Dr. Charles Kelly, Lead Investigator, MATTERHORN Trial.
The findings have been met with enthusiasm by the medical community, offering renewed hope for patients facing this aggressive cancer. The data supports the growing role of immunotherapy in the treatment of gastrointestinal
