Triple threat.

This has been a bad summer for GI cancers. So we are happy to bring you the positive results of the Phase 3 FLOT 4 trial which was presented as a late-breaking abstract at ESMO 2017. Perioperative triplet therapy with 5FU with leucovorin, oxaliplatin and Taxotere (FLOT) was put up against the standard epirubicin, cisplatin, and 5FU (ECF) for 713 patients with resectable esophagogastric junction (EGJ) or gastric cancers. FLOT significantly improved R0 resection rates from 77-> 88% and impressively improved median overall survival (MS) 35 -> 50 months. This advantage held across all pre-defined subsets including the notoriously poor performers: elderly patients and those with signet cell histologies. Importantly, even with this improved chemo regimen, 87% of all recurrences included distant sites serving as a stark reminder that this disease is a systemic one. Nonetheless, these noteworthy survival outcomes position FLOT to challenge all three GEJ/gastric treatment regimens established in the landmark MAGIC (MS: 24 months), CROSS (MS: 43 months), and McDonald (MS: 35 months) trials. Now that's what we call a triplet therapy triple threat.