Managing FLOT Tolerability, Assessing Pathologic Response, and Addressing Unmet Needs in the Perioperative Setting

This segment focuses on real-world challenges in perioperative management, beginning with the tolerability of FLOT in extended neoadjuvant strategies. The panel discusses how neuropathy commonly emerges after several cycles, prompting careful monitoring and selective dose reductions rather than routine drug omission. Supportive care, anticipatory counseling, and prehabilitation are emphasized as key to helping patients maintain treatment intensity. The conversation then shifts to postoperative scenarios in which pathology reveals minimal or no response to preoperative therapy. The panel explains that radiographic and gross intraoperative impressions may not always align with reported pathologic response, creating clinical uncertainty. When true lack of response is evident, current practice often defaults to continuing the same regimen, though the panel notes that evidence guiding alternative postoperative strategies is limited. Biomarker testing, including HER2, MSI/MMR, PD-L1, and CLDN18.2, is reviewed as a growing component of decision making. The segment concludes with discussion of immunotherapy-related considerations and recognition of the unmet need for clinical trials to guide management when neoadjuvant therapy is ineffective.