Would you consider giving FLOT entirely in the neoadjuvant setting for resectable gastric cancer?

I do favor trying to give all the chemotherapy upfront, including FLOT. This builds upon compelling data from other GI cancers, like rectal cancer and pancreas adenocarcinoma, and the evidence that there has never been a trial (to my knowledge) that showed worse outcomes with total upfront chemo, vs split chemo as was done in the FLOT study. Patients tolerate most things, but especially chemotherapy and supportive care medications, with an intact stomach.

I would only consider neoadjuvant treatment for MSI-H patients using immunotherapy with chemotherapy for resectable gastric cancer, based on the data from DANTE and NEONIPIGA study. For patients with MSS status, I would favor peri-operative chemotherapy.