From Trial to Practice: Considerations for Delivering FLOT + IO to Patients

Video content above is prompted by the following:

The toxicity profile of D-FLOT appears manageable and consistent with expectations, showing minimal additional adverse events compared with FLOT alone. Although FLOT carries known individual drug toxicities, including fatigue, nausea, and weight loss concerns, for surgical colleagues, the addition of durvalumab did not significantly increase treatment-related complications or prevent patients from proceeding to surgery. The trial data showed comparable rates of patients unable to reach surgery in both arms, with only single-digit percentages affected. Immune-related adverse events from durvalumab were observed but remained within acceptable ranges, providing reassurance about the safety profile of the combination regimen.

Practical implementation of D-FLOT requires careful patient selection and monitoring, though no specific additional assessments beyond standard oncologic evaluation appear necessary. Oncologists’ existing expertise in assessing performance status and comorbidities applies directly to D-FLOT candidacy. The multidisciplinary approach becomes even more critical, with surgical colleagues helping identify additional risk factors such as pulmonary or cardiac disease during concurrent workup. Standard supportive care measures, including growth factor support, nutritional consultation, and social work involvement, remain essential components of successful treatment delivery. Dose modifications and reductions, commonly needed with FLOT, remain acceptable approaches to maintaining treatment tolerability.

Presurgical assessment focuses on practical markers of recovery and nutritional status, including the “eyeball test” of overall patient appearance, albumin levels as surgical risk predictors, and detailed discussion of daily nutritional intake. Many patients experience improved eating ability after neoadjuvant therapy if their initial presentation involved tumor-related obstruction or dietary limitations. The surgical team evaluates patients’ return to normal activities and overall functional status as key indicators of readiness for surgery. Recovery timelines allow flexibility, with postsurgical intervals of 4 to 12 weeks before adjuvant therapy initiation, providing adequate time for patients to recover sufficiently to complete their treatment course and derive maximum benefit from the perioperative approach.