Latest Cancer TreatmentsDr. Mohammadreza Dabiri
Dr. Mohammadreza Dabiriفارسی
Treatment regimen

FLOT regimen: dose and schedule in gastric and oesophageal cancer

Docetaxel, oxaliplatin, leucovorin and fluorouracil every 2 weeks; 4 cycles before and 4 cycles after surgery

Updated: 28 October 20261 min read2 references

Summary for doctors

  • Resectable gastric or gastro-oesophageal junction adenocarcinoma (cT2 or more, or N+‎) [1].
  • 4 cycles before surgery and 4 cycles after [1].
  • Neutropenia is common; G-CSF in many patients.

Dose and schedule

FLOT

Resectable gastric or GEJ cancer; before and after surgeryCycle length: Every 14 days

Resectable gastric or GEJ cancer; before and after surgery

DrugDoseRouteSchedule
Docetaxel50 mg/m²IV over 1 hourDay 1
Oxaliplatin85 mg/m²IV over 2 hoursDay 1
Leucovorin200 mg/m²IVDay 1
Fluorouracil2600 mg/m²Continuous 24-hour infusionDay 1
Cycle length
Every 14 days
Duration
4 cycles before surgery + 4 cycles after surgery

Doses as in the FLOT4 study [1]. Adding durvalumab to FLOT has been studied in the MATTERHORN trial (news).

Evidence: FLOT4 (2019)

Doses follow the trial protocol, guideline or official drug label (source given in the notes of each regimen). Before prescribing, check blood counts, renal and hepatic function, drug interactions and the patient’s condition, and adjust the dose according to the drug label.

Premedication and supportive care

  • Docetaxel premedication: dexamethasone (per local protocol).
  • Antiemetics: 5-HT3 and dexamethasone.
  • Consider G-CSF prophylaxis (G-CSF tool).
  • DPYD: before the first fluoropyrimidine dose, consider testing for DPD deficiency (DPYD genotype); in carriers of one reduced-function allele the starting dose is reduced by about 50%, and these drugs are contraindicated in complete deficiency [2].

Monitoring and dose adjustment

  • Full blood count before each cycle; common thresholds ANC 1500 and platelets 100,000.
  • Neuropathy and fluid retention (docetaxel); diarrhoea and mucositis (fluorouracil).
  • After surgery, many patients do not complete the postoperative cycles; optimise nutrition before starting.

Main evidence

Show detailsHide

FLOT4: compared with ECF/ECX, FLOT increased median overall survival from 35 to 50 months with more pathological complete responses and no increase in postoperative deaths [1].

Related cancer types

Stomach cancerOesophageal cancer

Treatment regimens (physicians)

FOLFOX (mFOLFOX6): dose, schedule and side effectsCAPOX (XELOX): dose, schedule and side effectsFOLFIRI regimen: dose, schedule and side effectsCROSS regimen: chemoradiotherapy before oesophageal surgeryNivolumab with CAPOX or FOLFOX in gastric cancer (CheckMate 649)Trastuzumab deruxtecan (T-DXd, Enhertu): dose and monitoring

Physician tools and lessons

Khorana Score (Cancer-Associated Thrombosis Risk)10 cheap steps that save patients' lives

References

2 references
Show all references, 2 with a study cardClose the reference list

Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.

  1. 1
    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 trialAl-Batran SE, Homann N, Pauligk C, et al · Lancet · 2019;393:1948-1957
    Study cardDOIPubMed Back to text: 1 2 3 4
  2. 2
    Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Dihydropyrimidine Dehydrogenase Genotype and Fluoropyrimidine Dosing: 2017 UpdateAmstutz U, Henricks LM, Offer SM, et al · Clin Pharmacol Ther · 2018;103:210-216
    Study cardDOIPubMed Back to text

This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.

Printed from the website; the full and up-to-date version: https://drdabiri.com/en/regimens/flot/

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27 October 2026 FOLFOX (mFOLFOX6): dose, schedule and side effects Dose and schedule of mFOLFOX6 (oxaliplatin 85, leucovorin 400, fluorouracil 400 bolus and 2400 as a 46-hour infusion), length of adjuvant treatment, premedication, neuropathy and dose adjustment. 27 October 2026 CAPOX (XELOX): dose, schedule and side effects Dose and schedule of CAPOX or XELOX (oxaliplatin 130 and capecitabine 1000 twice daily, days 1 to 14), length of adjuvant treatment, renal adjustment and side effects. 27 October 2026 FOLFIRI regimen: dose, schedule and side effects Dose and schedule of FOLFIRI (irinotecan 180, leucovorin 400, fluorouracil 400 bolus and 2400 as a 46-hour infusion), diarrhoea control, UGT1A1 and dose adjustment.