Integrating PD-L1 Testing and Practical Implications for DFLOT Adoption

This segment explores how biomarker testing, subgroup interpretation, and pathologic response patterns may guide real-world use of DFLOT in the perioperative setting. The discussion begins with whether PD-L1 testing should become routine before choosing between FLOT and DFLOT. The panel notes that PD-L1, MSI/MMR, and HER2 are increasingly incorporated into reflex testing workflows, and timely biomarker reporting can help avoid delays in neoadjuvant decision making. While some institutions may wait for PD-L1 results, the panel acknowledges that logistical constraints in community settings may lead to broader use of DFLOT irrespective of PD-L1 status. The conversation then shifts to new EFS data from MATTERHORN, highlighting how DFLOT improved event-free survival across categories, including pathologic complete response, major response, any response, and node-negative or node-positive disease, although several subgroup confidence intervals cross 1, reinforcing the need for cautious interpretation. The panel also discusses the prognostic significance of nodal status and the notable proportion of patients who remain node-positive after therapy. Overall, the segment emphasizes how evolving biomarker practices and detailed pathologic response analyses will inform personalized incorporation of DFLOT as more real-world experience becomes available.