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The combination of FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) with the monoclonal antibodies trastuzumab and pertuzumab is an investigational regimen for the perioperative treatment of HER2-positive resectable gastric or gastroesophageal junction adenocarcinoma. Trastuzumab and pertuzumab are both HER2-targeted monoclonal antibodies that bind to different epitopes on the human epidermal growth factor receptor 2 (HER2), inhibiting its signaling and promoting antibody-dependent cellular cytotoxicity. The addition of these agents to standard FLOT chemotherapy has demonstrated improved pathologic complete response rates and nodal negativity in clinical trials but is associated with increased toxicity such as diarrhea and leukopenia[2][3][4][5]. This regimen is not currently approved for this indication but has been studied in phase II/III trials such as PETRARCA (NCT02581462) and HERFLOT.
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