Linitis plastica medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

The mainstay therapy for linitis plastica is surgical. However, in the case of linitis plastica adjuvant or neoadjuvant therapy is preferred concomitantly with surgery or prior to surgery to avoid future morbidities.

Medical Therapy

Pharmacologic medical therapy is recommended among patients with linitis plastica who are at higher risk for metastasis.

Linitis plastica

  • FLOT regimen is recommended as neoadjuvant therapy in those with linitis plastica, since it has proven higher survival rates.[1][2][3]
  • The FLOT regimen is associated with a higher response rate (16 percent versus 8 percent), and has less toxicity which generally makes it more favorable.
  • 1 Stage 1 - FLOT regimen
    • 1.1 Stomach
      • 1.1.1 Adult
        • Preferred regimen (1):Docetaxel 50 mg/m2 every 2 weeks for 4 cycles preoperative and post-operative
        • Preferred regimen (2):Leucovorin 200 mg/m2 every 2 weeks for 4 cycles preoperative and post-operative
        • Preferred regimen (3): Oxaliplatin85 mg/m2 every 2 weeks for 4 cycles preoperative and post-operative
        • Preferred regimen (4): Fluorouracil 2600 mg/m2 every 2 weeks for 4 cycles preoperative and post-operative
        • Alternative regimen (1): FLOT regimen with Epirubicin 50 mg/m2 every 2 weeks for 3 cycles preoperative and post-operative on day 1
        • Alternative regimen (2): FLOT regimen with Cisplatin 60 mg/m2 every 2 weeks for 3 cycles preoperative and post-operative on day 1
Drug Dose
Oxaliplatin 85 mg/m2 IV
Leucovorin 200 mg/m2 IV
Fluorouracil 2600 mg/m2 as a 24-hour infusion
Docetaxel  50 mg/m2

References

  1. Al-Batran SE, Hofheinz RD, Pauligk C, Kopp HG, Haag GM, Luley KB; et al. (2016). "Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial". Lancet Oncol. 17 (12): 1697–1708. doi:10.1016/S1470-2045(16)30531-9. PMID 27776843.
  2. Anter AH, Abdel-Latif RM (2013). "The safety and efficacy of fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) combination in the front-line treatment for patients with advanced gastric or gastroesophageal adenocarcinoma: phase II trial". Med Oncol. 30 (1): 451. doi:10.1007/s12032-012-0451-1. PMID 23307258.
  3. Al-Batran SE, Hartmann JT, Hofheinz R, Homann N, Rethwisch V, Probst S, Stoehlmacher J, Clemens MR, Mahlberg R, Fritz M, Seipelt G, Sievert M, Pauligk C, Atmaca A, Jäger E (2008). "Biweekly fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) for patients with metastatic adenocarcinoma of the stomach or esophagogastric junction: a phase II trial of the Arbeitsgemeinschaft Internistische Onkologie". Ann. Oncol. 19 (11): 1882–7. doi:10.1093/annonc/mdn403. PMID 18669868.

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