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Hi, behind the Night. Happy 2002, hoping for a better year this year. I'm Kate Lynn Huster. I'm one of the second year CGSO fellows at MD Anderson. And I am joined by Gilbert Maroma. You want to introduce yourself Gilbert?

Yeah, I'm one of the PGY three residents at UT Southwestern. I'm currently in my first year in the lab.

And we're very excited to come to you today to discuss two key trials for gastric cancer. One for the operative management of localized gastric cancer.

And then one that is actually for non resectable locally advanced gastric cancer or metastonic gastric cancer, but that we feel have implications to eventually translate over into the surgical cohort of patients.

And so the first study we're going to be talking about is the flat four study. And Gilbert, do you want to just tell us a little bit of background on why the flat four study came to be?

Yeah, absolutely. So before flat came about, there was the magic trial which kind of set up the standard of care for patients with gastric cancer that was locally advanced, but resectable. And despite advances in therapy and treatment survival will still

be unacceptably low for these patients. And so there are ongoing trials and sort of determine what regimen may better improve survival in these patients. And based on some data and the metastatic set in the metastatic section where patients had increased pathological complete response.

Based on this flat regimen, it was moved to a phase two and three trial and the resectable cohort of patients who add up to local advanced disease.

And so when I started residency and even when I was a third year resident at UT Southwestern, where you're sitting right now, Gilbert, we didn't talk about flood that came later on in my residency and the standard of care at that point was magic for gastric cancer and the cross trial for G junction cancer.

And what the magic trial looked at is patients who had localized gastric cancer, whether perioperative chemotherapy, a sandwich approach of ECF.

And with three cycles preoperatively, three cycles postoperatively versus surgery alone, if there were differences and outcomes for those patients.

And indeed, magic found that patients who who received this sandwich approach of perioperative chemotherapy had a five year survival rate of 36% versus those who had upfront surgery with 23%.

And then what cross showed was more of the esophageal aspect of things, the GE junction tumors and established the basis for using platinum based chemotherapy with radiation.

So carbon platinum packed with tax all with radiation to improve survival.

And so from that, we then expanded the way we think about gastric cancer and perioperative chemotherapy and the potential benefits for getting micrometastatic disease control and seemingly localized gastric cancers.

And we have now continue this on to consider different regimens, including the flock.

And so tell us a little bit about what the phase two portion of this study was Gilbert and what the phase three portion of the study is currently that we're presenting today.

The phase two portion of the study covered the first 300 patients of the population and was published back in 2017.

Basically, that showed that flock was superior to ECF or ECX in terms of complete pathological response, which coincided with the data that kind of launched the reason for this.

So they saw a rate of 15% versus 6% in the phase two portion of the trial and then carried it out to phase three and rolling the rest of this trial and looking at a primary and way of overall survival.

Okay.

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