How is durvalumab administered when combined with the FLOT (5‑fluorouracil, leucovorin, oxaliplatin, docetaxel) regimen?

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Administración de Durvalumab Asociado a FLOT

Durvalumab no está aprobado ni estudiado en combinación con el régimen FLOT (5-fluorouracilo, leucovorina, oxaliplatino, docetaxel) para cáncer gástrico o gastroesofágico, y no existe evidencia que respalde esta combinación específica.

Contexto del Régimen FLOT

El régimen FLOT se utiliza principalmente para cáncer gástrico localmente avanzado en esquema perioperatorio 1. Durante la pandemia de COVID-19, las guías recomendaron considerar FLOT con factor estimulante de colonias de granulocitos (G-CSF) o cambiar a CapOx (capecitabina-oxaliplatino) si no hay disfagia 1.

Uso Aprobado de Durvalumab en Otros Contextos

Durvalumab tiene aprobaciones establecidas en contextos completamente diferentes:

Cáncer de Pulmón de Células Pequeñas Extenso

  • Durvalumab 1500 mg IV cada 4 semanas en combinación con etopósido más carboplatino o cisplatino por 4 ciclos, seguido de durvalumab de mantenimiento 1500 mg cada 4 semanas 1
  • Esta es una recomendación categoría 1 basada en el estudio CASPIAN que demostró supervivencia global mediana de 13.0 meses versus 10.3 meses con quimioterapia sola 1

Cáncer de Pulmón de Células No Pequeñas Estadio III

  • Durvalumab 10 mg/kg IV cada 2 semanas después de quimiorradioterapia concurrente sin progresión, por hasta 12 meses 1, 2
  • El estudio PACIFIC demostró supervivencia global mediana de 47.5 meses versus 29.1 meses con placebo 1

Ajustes de Frecuencia Durante COVID-19

  • Para reducir visitas hospitalarias, se recomendó aumentar la dosis de durvalumab de 1200 mg cada 3 semanas a 1500 mg cada 4 semanas 1
  • Esta modificación se basó en la vida media de eliminación de 12 días del durvalumab 1

Consideraciones Importantes

No existe evidencia clínica que respalde la combinación de durvalumab con FLOT. Los estudios de durvalumab en cáncer gastroesofágico no han utilizado el régimen FLOT como base 1.

Si se está considerando inmunoterapia para cáncer gástrico/gastroesofágico avanzado, las combinaciones estudiadas incluyen:

  • Atezolizumab-bevacizumab (no con FLOT) 1
  • Durvalumab-tremelimumab (no con FLOT) 1

Advertencia crítica: Combinar durvalumab con FLOT sería uso fuera de indicación sin datos de seguridad o eficacia, con riesgo potencial de toxicidad aumentada por la combinación de quimioterapia intensiva (4 fármacos) más inmunoterapia 1.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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