DCF and FLOT: — Your Stomach Cancer Chemotherapy Explained

FLOT contains four drugs — fluorouracil, leucovorin, oxaliplatin, and docetaxel. DCF contains three — docetaxel, cisplatin, and fluorouracil. Both share docetaxel and fluorouracil. ESMO and NCCN guidelines list FLOT as the preferred perioperative regimen for resectable gastric cancer. DCF is used in some centres for locally advanced or metastatic disease. The choice depends on the stage of the cancer, whether surgery is planned, and your kidney function and overall fitness.

FLOT as a perioperative regimen is designed for cancers that are potentially removable by surgery. If the cancer has spread to other organs, a different treatment approach is usually made. DCF has been used in locally advanced or metastatic disease, though the regimen and treatment goals differ from the perioperative setting. Your oncologist will explain what the appropriate plan is for your specific stage and situation.

Hair thinning or loss is common with both FLOT and DCF, mainly because of the docetaxel component. For most people it is temporary — hair usually regrows after treatment ends, though the timing and extent vary from person to person. Tell your team early if this is a concern; they can offer practical advice about what to expect with your specific regimen.

Eating well during treatment matters, and your team will want to know if your appetite or ability to swallow changes. Nausea is common, especially in the days after each cycle, and anti-nausea medicines are usually prescribed alongside the chemotherapy. Mouth soreness can make eating uncomfortable during some cycles. Ask your team whether a dietitian referral has been arranged — this is standard in most gastric cancer programmes.

A fever during chemotherapy is a same-day call to your treatment centre — not something to wait out until your next appointment. Low blood counts after each cycle can reduce your body's ability to fight infection, and a fever may be the first sign of a serious problem. Your oncologist will give you a specific protocol for this at the start of treatment. Follow it, and when in doubt, call on the same day.

After the preoperative cycles, your oncologist will arrange imaging to assess the tumour. The scan compares its appearance against the original staging images. Even when the tumour appears smaller on imaging, the pathology report after surgery often gives the most detailed picture of how the cancer responded. Your team will explain what the scan shows and what it means for the surgical plan.