FLOT chemotherapy is a multi-drug regimen that treats specific cancers. It combines several medications to target and eliminate cancer cells. It is primarily used for certain gastrointestinal cancers.
Understanding FLOT Components and Application
FLOT is an acronym for its four distinct drugs: 5-fluorouracil (5-FU), leucovorin, oxaliplatin, and docetaxel. 5-FU is an antimetabolite that disrupts DNA and RNA synthesis, hindering cancer cell growth. Leucovorin, also known as folinic acid, enhances the effect of 5-FU by stabilizing its binding to a target protein within cancer cells, making 5-FU more effective.
Oxaliplatin is a platinum-based an alkylating agent. It damages cancer cell DNA by forming adducts, preventing DNA replication and leading to programmed cell death. Docetaxel, a taxane, interferes with cell division by stabilizing microtubules, which are essential for cell splitting, thereby stopping cancer cells from multiplying. This combined action maximizes the impact on rapidly dividing cancer cells.
FLOT chemotherapy is primarily prescribed for cancers of the stomach, esophagus, and the gastroesophageal junction, the area where the stomach meets the esophagus. It is a standard treatment for localized or resectable tumors where surgery is a possibility. The regimen is frequently used in a perioperative setting, before and after surgery, to shrink tumors and eliminate residual cancer cells.
The Treatment Process
FLOT chemotherapy is typically administered intravenously into the bloodstream through a vein. This can be done via a central line, PICC line, portacath, or a cannula inserted into an arm vein. Patients typically receive treatment in a chemotherapy day unit or during a hospital stay, though some components may be administered at home.
A FLOT cycle typically lasts 14 days. On day one, docetaxel is infused over approximately one hour, followed by oxaliplatin and leucovorin, each administered over about two hours. 5-fluorouracil is then given as a continuous 24-hour infusion, often using a portable pump that patients can wear home. After the 5-FU infusion is complete, a rest period follows until the next cycle begins on day 15.
A full course of FLOT generally involves eight cycles. For patients undergoing surgery, four cycles are typically given before the operation (neoadjuvant chemotherapy) and four cycles after recovery from surgery (adjuvant chemotherapy). Surgery is commonly scheduled around four weeks after the completion of the fourth FLOT cycle. The entire treatment duration can last between five to six months, depending on individual patient response and recovery.
Navigating Side Effects
FLOT chemotherapy can cause side effects because it targets rapidly dividing cells, including healthy cells in the bone marrow, hair follicles, and digestive tract. Common gastrointestinal side effects include nausea, vomiting, diarrhea, and mouth sores. Antiemetics are often prescribed to help manage nausea and vomiting. Maintaining good oral hygiene can also alleviate mouth soreness.
Frequent hematological side effects include reduced blood cell counts. This can manifest as an increased risk of infection due to low white blood cell counts (neutropenia), fatigue and breathlessness from low red blood cells (anemia), and easy bruising or bleeding from low platelets. Growth factors may be given to support white blood cell production and reduce infection risk. Patients are advised to report any signs of infection, such as fever, immediately.
Neurological effects, particularly peripheral neuropathy, can cause numbness, tingling, or pain in the hands and feet. This symptom is often associated with oxaliplatin and can be exacerbated by cold temperatures. While it can improve after treatment, it may persist for some individuals. Other potential side effects include hair loss, changes in taste, fatigue, skin reactions (such as redness or rashes), and nail changes. Patients are encouraged to communicate all symptoms to their medical team, as dosages may be adjusted or supportive care provided to manage these effects.
Treatment Outcomes
FLOT chemotherapy aims to improve outcomes for patients with gastric, esophageal, and gastroesophageal junction cancers. A primary goal is often to shrink the tumor before surgery, making it easier to remove completely, a process known as neoadjuvant therapy. Following surgery, FLOT works to eliminate any remaining cancer cells, thereby reducing the risk of the cancer returning.
Clinical studies have demonstrated that FLOT can increase overall survival rates in treated patients. For instance, research comparing FLOT to older chemotherapy regimens for gastric and gastroesophageal junction cancer has shown improved survival with FLOT. The effectiveness of FLOT can vary based on individual factors like the stage of cancer and the patient’s overall health. Completing the full perioperative regimen, both before and after surgery, is considered important for achieving the best results.