Managing Toxicity, Monitoring Needs, and Logistical Realities of DFLOT in Perioperative Care

This segment examines anticipated toxicities, postoperative monitoring needs, and practical considerations when offering DFLOT in the perioperative setting. The discussion starts with expectations around immune-mediated adverse events during neoadjuvant therapy. Panelists note that while DFLOT introduces additional immune-related risks, most events occur at low frequencies and are typically manageable with established algorithms. They emphasize the importance of distinguishing grade 1–2 toxicities, which are often treated symptomatically, from grade 3–4 events that may require holding immunotherapy. The conversation then moves to the postoperative phase, where gastric surgery recovery is already challenging. Panelists weigh whether the year-long immunotherapy component provides closer follow-up opportunities or adds an additional burden for patients struggling with weight loss and nutritional changes. Finally, the segment addresses real-world logistics, including infusion-center capacity, travel burdens for rural patients, financial toxicity considerations, and how monthly immunotherapy visits may influence adherence. Overall, the panel underscores the need for individualized decision-making that balances benefit, tolerability, and feasibility.