Rinad Akhtar, MBBS1, Arisha Akhtar, MBBS1, Muhammad Hassan, MD2, Ali Naseem, MBBS3, Maha Sajjad, MBBS4, Amna Amjad, MBBS5, Muhammad Areeb Ul Haq, 6, Ammarah Tariq, MD7, Muhammad Mukhlis. Hussain, MBBS8, Mizhgan Abid, MBBS9, Aman Ullah, MBBS10, Moeen Ikram, MBBS11, Saad Ashraf, MBBS12 1Ziauddin University, Karachi, Sindh, Pakistan; 2Nuvance Health, Poughkeepsie, NY; 3King Edward Medical University, Lahore, Punjab, Pakistan; 4King Edward Medical University, Lahore, Lahore, Punjab, Pakistan; 5Fatima memorial hospital and college of medicine, Lahore, Punjab, Pakistan; 6Allama Iqbal Medical College, Lahore, Punjab, Pakistan; 7Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan; 8Ayub Medical College, Abbottabad, North-West Frontier, Pakistan; 9Khyber Girls Medical College, Peshawar, North-West Frontier, Pakistan; 10Quaid e Azam Medcal college, Queens, NY; 11Frontier Medical and Dental College, Abbottabad, Federally Administered Tribal Areas, Pakistan; 12Dow Medical College, Karachi, Sindh, Pakistan Introduction: Esophageal cancer is the sixth most common cancer worldwide and the fifth most common in the US. Currently, the standard curative treatment of choice for advanced esophageal cancer includes chemotherapy and radiotherapy. However, the effectiveness of these treatments in achieving sustained tumor control and improving overall survival remains limited. FLOT regimen (fluorouracil, leucovorin, oxaliplatin, docetaxel) is a new promising treatment approach that offers a superior therapeutic advantage over the current treatment options utilizing the combination of 5-fluorouracil, platinum salts, and taxanes. Methods: We systematically searched PubMed, EMBASE, and Cochrane databases through May 5, 2025, to include all randomized controlled trials (RCTs) and Observational studies for evaluating the efficacy of FLOT for the treatment of EC. The outcomes of interest in our meta- analysis were tumor resection rate, post operative mortality and morbidity, and grade 3/4 adverse events. Data was extracted and analyzed on RevMan v.5.4.1. The random-effects model was used to calculate the weighted pooled risk ratio (RR) with the corresponding 95% confidence intervals (CI) of our desired outcome. The I2 and χ2 statistics assessed heterogeneity with a p-value of < 0.05, considered statistically significant. Results: Our search identified a total of twelve studies with 6,032 patients (3,009 Intervention group; 3,023 Control group). We found that the use of FLOT demonstrated statistically significant results in tumor resection rate (RR 1.07, 95% CI 1.02 to 1.12, I2 =71%, P=0.003 Figure 1A), and postoperative mortality (RR 0.41, 95% CI 0.26 to 0.67, I2 =0%, P=0.0003 Figure 1B). However, it is notable that postoperative morbidity (RR 1.00 95% CI 0.83 to 1.22, I2 =0%, P=0.98); and grade 3/4 adverse events (RR 0.82 95% CI 0.60 to 1.11, I2 =0%, P=0.20) showed no statistically significant benefit with the combination treatment. Discussion: Our meta-analysis demonstrated that the FLOT regimen improves patient prognosis by enhancing tumor resection rate and reducing postoperative mortality in esophageal cancer. However, it also demonstrated that FLOT therapy showed no statistically significant benefit on post operative morbidity, and grade 3/4 adverse events. Therefore, further large scale RCTs are needed to better understand the impact of FLOT therapy on Esophageal cancer.
Figure: Figure 1
Disclosures: Rinad Akhtar indicated no relevant financial relationships. Arisha Akhtar indicated no relevant financial relationships. Muhammad Hassan indicated no relevant financial relationships. Ali Naseem indicated no relevant financial relationships. Maha Sajjad indicated no relevant financial relationships. Amna Amjad indicated no relevant financial relationships. Muhammad Areeb Ul Haq indicated no relevant financial relationships. Ammarah Tariq indicated no relevant financial relationships. Muhammad Hussain indicated no relevant financial relationships. Mizhgan Abid indicated no relevant financial relationships. Aman Ullah indicated no relevant financial relationships. Moeen Ikram indicated no relevant financial relationships. Saad Ashraf indicated no relevant financial relationships.
Rinad Akhtar, MBBS1, Arisha Akhtar, MBBS1, Muhammad Hassan, MD2, Ali Naseem, MBBS3, Maha Sajjad, MBBS4, Amna Amjad, MBBS5, Muhammad Areeb Ul Haq, 6, Ammarah Tariq, MD7, Muhammad Mukhlis. Hussain, MBBS8, Mizhgan Abid, MBBS9, Aman Ullah, MBBS10, Moeen Ikram, MBBS11, Saad Ashraf, MBBS12. P2816 - Evaluating the Safety and Efficacy of FLOT Regimen in the Treatment of Esophageal Cancer: A Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
