DFLOT Implementation: Surgical Timing, Patient Selection, and the Evolving Role of Adjuvant Immunotherapy
Doctor Fontaine discusses the importance of patient selection for preoperative chemotherapy and the effectiveness of immune checkpoint inhibitors in surgery outcomes.
EP: 1.Selecting Neoadjuvant Strategies for Esophageal and GEJ Adenocarcinoma Across Multidisciplinary Practices
EP: 2.Current Standards in Resectable Gastric and GEJ Adenocarcinoma: Multidisciplinary Perspectives on Perioperative Management
EP: 3.Evaluating Total Neoadjuvant Approaches: Balancing Treatment Intensity, Surgical Timing, and Patient Selection
EP: 4.Managing FLOT Tolerability, Assessing Pathologic Response, and Addressing Unmet Needs in the Perioperative Setting
EP: 5.MATTERHORN Results Yield Promise in Resectable Gastric/GEJ Cancer
EP: 6.MATTERHORN Trial Design and DFLOT Adoption: Integrating Immunotherapy Into Perioperative Practice
EP: 7.DFLOT Implementation: Surgical Timing, Patient Selection, and the Evolving Role of Adjuvant Immunotherapy
This segment examines practical considerations for integrating DFLOT into perioperative workflows, with particular focus on surgical timing and the implications of combining intensive chemotherapy with immunotherapy. The panel discusses real-world observations that some patients experience delayed recovery after neoadjuvant FLOT or DFLOT, and a proportion may not proceed to surgery, highlighting the need for careful upfront selection and early identification of individuals who may require regimen adjustment or an alternative strategy such as definitive chemoradiation. The conversation also revisits PD-L1–based subgroup considerations, noting that low representation of PD-L1–negative disease limits interpretation of differential benefit, especially in regions where PD-L1 expression determines access to immunotherapy. The panel further considers whether patients who achieve a pathologic complete response after neoadjuvant DFLOT truly require prolonged postoperative immunotherapy, drawing parallels to other tumor types in which deep responses correlate with excellent long-term outcomes. The segment underscores the importance of biomarker-driven refinement and future trials to optimize duration and intensity of immunotherapy in the perioperative setting.
