About this episode
Oct 29
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How do we care for ourselves while caring for others?Surgery is a demanding profession that requires resilience, sacrifice, and the ability to navigate high-stakes decisions. However, depression, anxiety, burnout, and the emotional consequences of complications are realities that ... Show More
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5m 50s
Join the Behind the Knife Surgical Oncology Team as we discuss the MATTERHORN trial and the addition of perioperative immunotherapy to FLOT for resectable gastric and gastroesophageal junction adenocarcinoma!
Hosts:
- Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center.
- Daniel Nelson, DO, FACS (@usarmydoc24) is an Associate Professor of Surgery and Surgical Oncologist at the University of Tennessee Health Science Center, Chattanooga.
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a Surgical Oncologist at Brooke Army Medical Center.
- Joe (Joseph) Broderick, MD, MA (@joebrod5) is a General Surgery research resident between his second and third year at Brooke Army Medical Center.
- Galen Gist, MD (@gistgalen) is a third-year General Surgery resident at Brooke Army Medical Center.
Learning Objectives:
In this episode, we review the evolution of perioperative therapy for resectable gastric and gastroesophageal junction adenocarcinoma, from the MAGIC and FLOT4 trials to the MATTERHORN trial, a phase III randomized controlled trial investigating the addition of perioperative durvalumab to FLOT. We discuss the mechanism of checkpoint inhibition, the trial design, the event-free and overall survival results, the pathologic and nodal response data, and the open questions this trial raises for surgeons.
References used in the making of this episode:
- Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11-20. doi:10.1056/NEJMoa055531
- Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial. Lancet. 2019;393(10184):1948-1957. doi:10.1016/S0140-6736(18)32557-1
- Janjigian YY, Al-Batran SE, Wainberg ZA, et al. Perioperative durvalumab in gastric and gastroesophageal junction cancer. N Engl J Med. 2025;393(3):217-230. doi:10.1056/NEJMoa2503701
- Tabernero J, Al-Batran SE, Wainberg ZA, et al. Final overall survival and the association of pathological outcomes with event-free survival in MATTERHORN: a randomised, phase III study of durvalumab plus FLOT in resectable gastric/gastroesophageal junction adenocarcinoma. Presented at: European Society for Medical Oncology (ESMO) Congress 2025; October 17, 2025; Berlin, Germany. Abstract LBA81.
- Shitara K, Rha SY, Wyrwicz L, et al. Pembrolizumab plus chemotherapy versus chemotherapy as perioperative therapy in locally advanced gastric and gastroesophageal junction cancer: final analysis of the randomized, phase III KEYNOTE-585 study. J Clin Oncol. 2025;43(29):3152-3159. doi:10.1200/JCO-25-00486
- Kang YK, Terashima M, Kim YW, et al. Adjuvant nivolumab plus chemotherapy versus placebo plus chemotherapy for stage III gastric or gastro-oesophageal junction cancer after gastrectomy with D2 or more extensive lymph-node dissection (ATTRACTION-5): a randomised, multicentre, double-blind, placebo-controlled, phase 3 trial. Lancet Gastroenterol Hepatol. 2024;9(8):705-717. doi:10.1016/S2468-1253(24)00156-0
- André T, Tougeron D, Piessen G, et al. Neoadjuvant nivolumab plus ipilimumab and adjuvant nivolumab in localized deficient mismatch repair/microsatellite instability-high gastric or esophagogastric junction adenocarcinoma: the GERCOR NEONIPIGA phase II study. J Clin Oncol. 2023;41(2):255-265. doi:10.1200/JCO.22.00686
