Journal Review in Surgical Oncology: The MAGIC and FLOT-4 Landmark Trials

Behind The Knife: The Surgery Podcast

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4.8 • 1.4K Ratings

🗓️ 7 October 2024

⏱️ 28 minutes

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Summary

In this episode, we review key components of the landmark MAGIC and FLOT-4 trials that investigated perioperative chemotherapy in the treatment of locally advanced gastric cancer. We discuss limitations of both trials and the evolving clinical landscape of gastric cancer treatment.

Hosts:
- Timothy Vreeland, MD, FACS (@vreelant) is an Associate Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist/HPB surgeon at Brooke Army Medical Center.
- Daniel Nelson, DO, FACS (@usarmydoc24) is a Surgical Oncologist/HPB surgeon at Kaiser Permanente Los Angeles Medical Center.
- Connor Chick, MD (@connor_chick) is a Surgical Oncology Senior Fellow at Ohio State.
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncology Junior Fellow at MD Anderson Cancer Center.
- Beth (Elizabeth) Barbera, MD (@elizcarpenter16) is a PGY-6 General Surgery resident at Brooke Army Medical Center.

Learning Objectives:
1. Understand background, methodology, results, and interpretation of the MAGIC trial.
2. Understand background, methodology, results, and interpretation of the FLOT trial.
3. Be able to discuss the evolution of chemotherapeutic regimens in the treatment of locally advanced gastric cancer and rationale for their use.
4. Be able to describe key limitations for the above regimens.
5. Discuss the the evolving clinical landscape for chemotherapy in gastroesophageal junction tumors.

Links to Papers Referenced in this Episode:

Journal Articles:
Cunningham, D., Allum, W. H., Stenning, S. P., Thompson, J. N., Van de Velde, C. J., Nicolson, M., ... & Chua, Y. J. (2006). Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. New England Journal of Medicine, 355(1), 11-20.
https://pubmed.ncbi.nlm.nih.gov/16822992/

Al-Batran, S. E., Homann, N., Pauligk, C., Goetze, T. O., Meiler, J., Kasper, S., ... & Hofheinz, R. D. (2019). Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. The Lancet, 393(10184), 1948-1957.
https://pubmed.ncbi.nlm.nih.gov/30982686/

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Transcript

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0:00.0	Behind the surgery podcast, relevant and engaging content designed to help you dominate the day.
0:13.0	Hi everyone welcome back to another episode from your surgical oncology team. I'm
0:26.1	Elizabeth Barbara I'm from Brooklyn Medical Center. I'm a six-year resident there.
0:30.2	I'm Lexi Adams I'm a first-year fellow MD Anderson. In Connor Chick, I'm Lexi Adams. I'm a first year fellow at MD Anderson.
0:33.4	And Connor Chick, I'm a second year fellow at Ohio State.
0:35.8	And I'm Tim Breill and I'm a surgical oncologist from Brooke Army Medical Center.
0:39.0	We hope Dr. Nelson can join us for our next episode. He just recently graduated from an
0:43.8	H.P. fellowship at MD Anderson, but he's currently moving across the country right now.
0:48.1	We'll see him next time.
0:49.6	Firstly, we highly recommend you guys check out our most recent clinical challenges
0:52.8	episode which was published on May 23rd. This episode gives great context for
0:57.1	the work up and management about gastric adenote carcinoma which is going to be
1:00.6	super important as we transition today into a discussion about the two trials
1:04.4	that really revolutionize the peroperative chemo strategy for this disease.
1:08.4	We did have a tough time picking which articles we wanted to talk about today.
1:12.2	There's plenty of papers to discuss with gastric cancer,
1:14.9	especially when it comes to discussion
1:16.4	of lymphadnectomy approaches,
1:18.4	which we did talk about during our last episode.
1:21.3	But ultimately, we picked two trials that are definitely required reading in
1:24.4	surgical oncology. The Magic Trial published in the New England Journal of Medicine in
1:28.8	2006 by Cunningham and colleagues and the Flat for trial published in the Lancet in 2019
	...

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