Journal Review in Surgical Oncology: The MAGIC and FLOT-4 Landmark Trials

Behind The Knife: The Surgery Podcast

In this episode, we review key components of the landmark MAGIC and FLOT-4 trials that investigated perioperative chemotherapy in the treatment of locally advanced gastric cancer. We discuss limitations of both trials and the evolving clinical landscape of gastric cancer treatment.
Hosts:
- Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist/HPB surgeon at Brooke Army Medical Center.
- Daniel Nelson, DO, FACS (@usarmydoc24) is a Surgical Oncologist/HPB surgeon at Kaiser Permanente Los Angeles Medical Center.
- Connor Chick, MD (@connor_chick) is a Surgical Oncology Senior Fellow at Ohio State.
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncology Junior Fellow at MD Anderson Cancer Center.
- Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a PGY-6 General Surgery resident at Brooke Army Medical Center.
Learning Objectives:
1. Understand background, methodology, results, and interpretation of the MAGIC trial.
2. Understand background, methodology, results, and interpretation of the FLOT trial.
3. Be able to discuss the evolution of chemotherapeutic regimens in the treatment of locally advanced gastric cancer and rationale for their use.
4. Be able to describe key limitations for the above regimens.
5. Discuss the the evolving clinical landscape for chemotherapy in gastroesophageal junction tumors.
Links to Papers Referenced in this Episode:

Journal Articles:
Cunningham, D., Allum, W. H., Stenning, S. P., Thompson, J. N., Van de Velde, C. J., Nicolson, M., ... & Chua, Y. J. (2006). Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. New England Journal of Medicine, 355(1), 11-20.
https://pubmed.ncbi.nlm.nih.gov/16822992/

Al-Batran, S. E., Homann, N., Pauligk, C., Goetze, T. O., Meiler, J., Kasper, S., ... & Hofheinz, R. D. (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. The Lancet, 393(10184), 1948-1957.
https://pubmed.ncbi.nlm.nih.gov/30982686/
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