{"id":10131,"date":"2025-07-31T06:24:00","date_gmt":"2025-07-31T09:24:00","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=10131"},"modified":"2025-07-31T08:26:47","modified_gmt":"2025-07-31T11:26:47","slug":"tratamento-quimioterapico-dos-tumores-esofagogastricos-do-ecf-ao-flot-e-a-imunoterapia","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/tratamento-quimioterapico-dos-tumores-esofagogastricos-do-ecf-ao-flot-e-a-imunoterapia\/","title":{"rendered":"Tratamento Quimioter\u00e1pico dos Tumores Esofagog\u00e1stricos: do ECF ao FLOT e \u00e0 Imunoterapia"},"content":{"rendered":"<div class=\"pdfprnt-buttons pdfprnt-buttons-post pdfprnt-top-right\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/10131?print=pdf\" class=\"pdfprnt-button pdfprnt-button-pdf\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/pdf.png\" alt=\"image_pdf\" title=\"Ver PDF\" \/><\/a><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/10131?print=print\" class=\"pdfprnt-button pdfprnt-button-print\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/print.png\" alt=\"image_print\" title=\"Conte\u00fado de impress\u00e3o\" \/><\/a><\/div>\n<p>O manejo dos tumores da transi\u00e7\u00e3o esofagog\u00e1strica (TEG) e do est\u00f4mago localmente avan\u00e7ados evoluiu significativamente nas \u00faltimas duas d\u00e9cadas. Diversos estudos randomizados definiram os esquemas quimioter\u00e1picos mais eficazes no cen\u00e1rio perioperat\u00f3rio, estabelecendo o papel da quimiorradioterapia e, mais recentemente, da imunoterapia.<br>A seguir, revisitamos os estudos que moldaram esse panorama:<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-o-que-era-o-ecf\"><br><strong>O que era o ECF?<\/strong><\/h2>\n\n\n\n<p>O esquema ECF combinava:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Epirrubicina<\/li>\n\n\n\n<li>Cisplatina<\/li>\n\n\n\n<li>5-Fluorouracil (5-FU)<\/li>\n<\/ul>\n\n\n\n<p>Foi o padr\u00e3o estabelecido ap\u00f3s o MAGIC trial, publicado em 2006, que demonstrou melhora da sobrevida com quimioterapia perioperat\u00f3ria em rela\u00e7\u00e3o \u00e0 cirurgia isolada.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-o-estudo-magic\"><br><strong>O estudo MAGIC<\/strong><\/h2>\n\n\n\n<p>Publica\u00e7\u00e3o: NEJM, 2006<br>Desenho: fase III, randomizado<br>Popula\u00e7\u00e3o: pacientes com adenocarcinoma g\u00e1strico ou da jun\u00e7\u00e3o esofagog\u00e1strica<br>Interven\u00e7\u00e3o: cirurgia isolada vs. quimioterapia perioperat\u00f3ria com ECF (3 ciclos antes e 3 ap\u00f3s a cirurgia)<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-resultado\"><br><strong>Resultado:<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sobrevida global mediana: 24 meses (ECF) vs. 20 meses (cirurgia isolada)<\/li>\n\n\n\n<li>HR 0,75; p = 0,009<\/li>\n<\/ul>\n\n\n\n<p><strong>Conclus\u00e3o:<\/strong> o estudo consolidou o uso da quimioterapia perioperat\u00f3ria como novo padr\u00e3o na \u00e9poca.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-o-protocolo-cross\"><br><strong>O protocolo CROSS<\/strong><\/h2>\n\n\n\n<p>O CROSS trial (Van Hagen et al., NEJM, 2012) marcou uma virada no tratamento dos tumores do es\u00f4fago e da TEG, principalmente do tipo escamoso e adenocarcinomas Siewert I.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-intervencao\"><br><strong>Interven\u00e7\u00e3o:<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Carboplatina (AUC 2) + Paclitaxel (50 mg\/m\u00b2), 1x por semana por 5 semanas<\/li>\n\n\n\n<li>Radioterapia: 41,4 Gy em 23 fra\u00e7\u00f5es<\/li>\n\n\n\n<li>Cirurgia: 4 a 6 semanas ap\u00f3s t\u00e9rmino da RQT<\/li>\n\n\n\n<li>Sem quimioterapia adjuvante<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-resultado-0\"><br><strong>Resultado:<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sobrevida global mediana: 49 meses (RQT + cirurgia) vs. 24 meses (cirurgia isolada)<\/li>\n\n\n\n<li>HR = 0,657; p = 0,003<\/li>\n<\/ul>\n\n\n\n<p><strong>Conclus\u00e3o:<\/strong> CROSS estabeleceu a quimiorradioterapia neoadjuvante como padr\u00e3o para tumores do es\u00f4fago distal e TEG proximal.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-o-esquema-flot\"><br><strong>O esquema FLOT<\/strong><\/h2>\n\n\n\n<p>Diante da baixa efic\u00e1cia do ECF, o estudo FLOT4-AIO introduziu o esquema FLOT, mais intenso, mas com resultados superiores.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-flot\"><strong>FLOT:<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>5-FU: 2.600 mg\/m\u00b2 em infus\u00e3o cont\u00ednua por 24h (dia 1)<\/li>\n\n\n\n<li>Leucovorin: 200 mg\/m\u00b2 (dia 1)<\/li>\n\n\n\n<li>Oxaliplatina: 85 mg\/m\u00b2 (dia 1)<\/li>\n\n\n\n<li>Docetaxel: 50 mg\/m\u00b2 (dia 1)<\/li>\n\n\n\n<li>Ciclo a cada 14 dias<\/li>\n\n\n\n<li>4 ciclos antes e 4 ciclos ap\u00f3s a cirurgia (total de 8)<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-flot4-trial-lancet-2019\"><br><strong>FLOT4 trial (Lancet, 2019):<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Comparou FLOT vs. ECF\/ECX<\/li>\n\n\n\n<li>Sobrevida global mediana:\n<ul class=\"wp-block-list\">\n<li>FLOT: 50 meses<\/li>\n\n\n\n<li>ECF: 35 meses<\/li>\n\n\n\n<li>HR = 0,77; p = 0,012<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><br><strong>Conclus\u00e3o:<\/strong> FLOT tornou-se o novo padr\u00e3o perioperat\u00f3rio para tumores g\u00e1stricos e da TEG ressec\u00e1veis.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-topgear-trial\"><br><strong>TOPGEAR Trial<\/strong><\/h2>\n\n\n\n<p>Estudo fase II\/III que avaliou se adicionar quimiorradioterapia ao esquema perioperat\u00f3rio poderia melhorar os resultados em c\u00e2ncer g\u00e1strico e TEG.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bra\u00e7o A: quimioterapia perioperat\u00f3ria (FLOT ou ECF)<\/li>\n\n\n\n<li>Bra\u00e7o B: quimio neoadjuvante + quimiorradioterapia (45 Gy + cisplatina\/5-FU) + cirurgia + QT p\u00f3s-op<\/li>\n<\/ul>\n\n\n\n<p><br><strong>Resultados (fase II):<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Aumento da resposta patol\u00f3gica completa com RT<\/li>\n\n\n\n<li>Sem ganho estatisticamente significativo em sobrevida global at\u00e9 o momento<\/li>\n<\/ul>\n\n\n\n<p><strong>Refer\u00eancia:<\/strong> Lancet Oncol, 2021. Fase III em andamento.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-checkmate-577\"><br><strong>CheckMate-577<\/strong><\/h2>\n\n\n\n<p>Estudo fundamental no cen\u00e1rio adjuvante ap\u00f3s CROSS, para pacientes com doen\u00e7a residual.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Popula\u00e7\u00e3o: es\u00f4fago\/TEG p\u00f3s-RQT e cirurgia, sem resposta patol\u00f3gica completa<\/li>\n\n\n\n<li>Interven\u00e7\u00e3o:\n<ul class=\"wp-block-list\">\n<li>Nivolumabe vs. placebo por at\u00e9 1 ano<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-resultado-1\"><br><strong>Resultado:<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Sobrevida livre de doen\u00e7a: Nivolumabe: 22,4 meses | Placebo: 11,0 meses | HR = 0,69; p &lt; 0,001<\/li>\n<\/ul>\n\n\n\n<p><br><strong>Conclus\u00e3o:<\/strong> Estabeleceu nivolumabe como padr\u00e3o adjuvante nesse subgrupo.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-keynote-585\"><br><strong>KEYNOTE-585<\/strong><\/h2>\n\n\n\n<p>Avaliou o uso de pembrolizumabe perioperat\u00f3rio em c\u00e2ncer g\u00e1strico\/TEG ressec\u00e1vel.<br><br><strong>Interven\u00e7\u00e3o:<\/strong> QT baseada em platina + pembrolizumabe vs. QT + placebo<\/p>\n\n\n\n<h3 class=\"wp-block-heading\" id=\"h-resultado-interino-asco-gi-2024\"><strong>Resultado (interino \u2013 ASCO GI 2024):<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Aumento da resposta patol\u00f3gica completa<\/li>\n\n\n\n<li>Sem diferen\u00e7a significativa na sobrevida livre de eventos<\/li>\n<\/ul>\n\n\n\n<p><strong>Conclus\u00e3o:<\/strong> aguardando seguimento mais longo; n\u00e3o mudou a pr\u00e1tica cl\u00ednica at\u00e9 o momento.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-matterhorn\"><br><strong>MATTERHORN<\/strong><\/h2>\n\n\n\n<p>Estudo mais promissor at\u00e9 agora no uso de imunoterapia com FLOT.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Interven\u00e7\u00e3o: FLOT + durvalumabe vs. FLOT + placebo<\/li>\n\n\n\n<li>Resultados:\n<ul class=\"wp-block-list\">\n<li>Resposta patol\u00f3gica completa: Durvalumabe: 19,2% | Placebo: 7,2%<\/li>\n\n\n\n<li>Sobrevida livre de eventos em 2 anos: 67,4% (durvalumabe) vs. 58,5% (placebo)<\/li>\n\n\n\n<li>HR = 0,71; p &lt; 0,001<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><strong>Conclus\u00e3o: <\/strong>consolida a tend\u00eancia de integra\u00e7\u00e3o entre quimioterapia e imunoterapia no cen\u00e1rio perioperat\u00f3rio.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-comparativo-dos-principais-estudos\"><strong>Comparativo dos principais estudos<\/strong><\/h2>\n\n\n\n<p><\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes\"><div class=\"pcrstb-wrap\"><table class=\"has-fixed-layout\"><tbody><tr><td><strong>Estudo<\/strong><\/td><td><strong>Situa\u00e7\u00e3o cl\u00ednica<\/strong><\/td><td><strong>Interven\u00e7\u00e3o<\/strong><\/td><td><strong>Resultado relevante<\/strong><\/td><\/tr><tr><td>MAGIC<\/td><td>Perioperat\u00f3rio<\/td><td>ECF vs. cirurgia<\/td><td>ECF \u2191 sobrevida vs. cirurgia<\/td><\/tr><tr><td>CROSS<\/td><td>Neoadjuvante<\/td><td>QT + RT \u2192 cirurgia<\/td><td>\u2191 sobrevida global vs. cirurgia<\/td><\/tr><tr><td>FLOT4-AIO<\/td><td>Perioperat\u00f3rio<\/td><td>FLOT vs. ECF<\/td><td>FLOT superior em SG e resposta patol\u00f3gica<\/td><\/tr><tr><td>TOPGEAR<\/td><td>Perioperat\u00f3rio<\/td><td>FLOT \u00b1 RT<\/td><td>RT \u2191 resposta patol\u00f3gica (fase II)<\/td><\/tr><tr><td>CheckMate-577<\/td><td>Adjuvante<\/td><td>Nivolumabe vs. placebo<\/td><td>\u2191 sobrevida livre de doen\u00e7a<\/td><\/tr><tr><td>KEYNOTE-585<\/td><td>Perioperat\u00f3rio<\/td><td>Pembro + QT vs. QT<\/td><td>\u2191 resposta patol\u00f3gica, sem ganho em SLE<\/td><\/tr><tr><td>MATTERHORN<\/td><td>Perioperat\u00f3rio<\/td><td>FLOT + durvalumabe vs. FLOT<\/td><td>\u2191 resposta patol\u00f3gica e sobrevida livre de eventos<\/td><\/tr><\/tbody><\/table><\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-referencias\"><strong><br>Refer\u00eancias<\/strong><\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>MAGIC Trial<\/strong> &#8211; Cunningham D, Allum WH, Stenning SP, et al. <em>Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer.<\/em> <strong>N Engl J Med.<\/strong> 2006 Jul 6;355(1):11-20.<\/li>\n\n\n\n<li><strong>CROSS Trial<\/strong> &#8211; Van Hagen P, Hulshof MCCM, van Lanschot JJB, et al. <em>Preoperative chemoradiotherapy for esophageal or junctional cancer.<\/em> <strong>N Engl J Med.<\/strong> 2012 May 31;366(22):2074-2084.<\/li>\n\n\n\n<li><strong>FLOT4-AIO Trial<\/strong> -Al-Batran SE, Homann N, Pauligk C, et al. <em>Perioperative chemotherapy with FLOT versus ECF\/ECX for resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4-AIO): a multicentre, open-label, phase 3 trial.<\/em> <strong>Lancet.<\/strong> 2019 May 25;393(10184):1948\u20131957.<\/li>\n\n\n\n<li><strong>TOPGEAR Trial (fase II)<\/strong> &#8211; Leong T, Smithers BM, Haustermans K, et al. <em>TOPGEAR: a randomized phase II trial of preoperative chemotherapy with or without chemoradiation for resectable gastric cancer.<\/em> <strong>Lancet Oncol.<\/strong> 2021 Jan;22(1):e1-e15.<\/li>\n\n\n\n<li><strong>CheckMate-577<\/strong> &#8211; Kelly RJ, Ajani JA, Kuzdzal J, et al. <em>Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer.<\/em> <strong>N Engl J Med.<\/strong> 2021 Apr 1;384(13):1191\u20131203.<\/li>\n\n\n\n<li><strong>KEYNOTE-585 (Interim)<\/strong> &#8211; Shitara K, van Cutsem E, Ajani JA, et al. <em>Neoadjuvant and adjuvant pembrolizumab plus chemotherapy in locally advanced gastric or gastro-oesophageal cancer (KEYNOTE-585): an interim analysis of the multicentre, double-blind, randomised phase 3 study.<\/em> <strong>Lancet Oncol.<\/strong> 2024 Feb;25(2):212\u2013224.<\/li>\n\n\n\n<li><strong>MATTERHORN<\/strong> &#8211; Janjigian YY, Al-Batran SE, Wainberg ZA, Muro K, Molena D, Van Cutsem E, et al. Perioperative Durvalumab in Gastric and Gastroesophageal Junction Cancer.<br>N Engl J Med. 2025.<\/li>\n<\/ol>\n\n\n\n<h2 class=\"wp-block-heading\" id=\"h-como-citar-este-artigo\"><strong>Como citar este artigo<\/strong><\/h2>\n\n\n\n<p class=\"has-very-light-gray-to-cyan-bluish-gray-gradient-background has-background\">Martins BC. Tratamento Quimioter\u00e1pico dos Tumores Esofagog\u00e1stricos: do ECF ao FLOT e \u00e0 Imunoterapia Gastropedia 2025; Vol II. Dispon\u00edvel em: <a href=\"https:\/\/gastropedia.pub\/pt\/?p=10131\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/gastropedia.pub\/pt\/gastroenterologia\/tratamento-quimioterapico-dos-tumores-esofagogastricos-do-ecf-ao-flot-e-a-imunoterapia\/<\/a><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>O manejo dos tumores da transi\u00e7\u00e3o esofagog\u00e1strica (TEG) e do est\u00f4mago localmente avan\u00e7ados evoluiu significativamente nas \u00faltimas duas d\u00e9cadas. Diversos estudos randomizados definiram os esquemas quimioter\u00e1picos mais eficazes no cen\u00e1rio&hellip;<\/p>\n","protected":false},"author":722,"featured_media":10146,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[19,20,18],"tags":[],"ano":[413],"tipo":[121],"volume":[44],"class_list":["post-10131","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-esofago","category-estomago","category-gastroenterologia","ano-413","tipo-assuntos-gerais","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Tratamento Quimioter\u00e1pico dos Tumores Esofagog\u00e1stricos: do ECF ao FLOT e \u00e0 Imunoterapia - Gastropedia<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/tratamento-quimioterapico-dos-tumores-esofagogastricos-do-ecf-ao-flot-e-a-imunoterapia\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Tratamento Quimioter\u00e1pico dos Tumores Esofagog\u00e1stricos: do ECF ao FLOT e \u00e0 Imunoterapia\" \/>\n<meta property=\"og:description\" content=\"O manejo dos tumores da transi\u00e7\u00e3o esofagog\u00e1strica (TEG) e do est\u00f4mago localmente avan\u00e7ados evoluiu significativamente nas \u00faltimas duas d\u00e9cadas. 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