FLOT

Say it: FLOT (rhymes with lot)

Fluorouracil, leucovorin, oxaliplatin and docetaxel

FLOT is a strong four medicine chemotherapy plan given before and after surgery for stomach and lower esophagus cancer.

Also called: FLOT4, perioperative FLOT, FLOT plus durvalumab, FLOT with durvalumab, durvalumab FLOT, 5-FU, leucovorin, oxaliplatin and docetaxel

What it is

Fluorouracil (5-FU), oxaliplatin and docetaxel each attack cancer cells in a different way, and leucovorin helps fluorouracil work better. Giving chemotherapy before surgery can shrink the tumor and treat cancer cells that may have spread. Giving more after surgery helps lower the chance the cancer comes back. The goal is cure.

Often used for

• Stomach or gastroesophageal junction (where the esophagus meets the stomach) cancer, given before and after surgery
• Esophagus adenocarcinoma, given before and after surgery
• Sometimes stomach or esophagus cancer that has spread, in people who are fit enough

Perioperative FLOT

The standard plan: 4 cycles (about 8 weeks) before surgery, a break to have surgery and recover, then 4 more cycles after surgery. Some people cannot finish all the cycles after surgery, and your team will adjust as needed.

FLOT plus durvalumab

A newer version for stomach and gastroesophageal junction cancer. Durvalumab is given every 4 weeks along with FLOT before and after surgery, then continues alone for up to about 10 more doses (close to a year in total). It may cause immune side effects such as rash, diarrhea, cough or thyroid changes.

FLOT for esophagus adenocarcinoma

For adenocarcinoma of the lower esophagus, FLOT before and after surgery is now a preferred choice for many people instead of chemotherapy with radiation before surgery. Your team will explain which plan fits you.

The medicines in this plan

Docetaxel

Chemotherapy that stops cancer cells from dividing. Given through a vein over about 1 hour on day 1. A main cause of low white blood cell counts and hair loss.

Oxaliplatin

Platinum chemotherapy. Given through a vein over about 2 hours on day 1. It is the medicine that causes cold sensitivity and tingling.

Leucovorin

A form of folic acid that makes fluorouracil work better. Given through a vein over about 1 to 2 hours on day 1.

Fluorouracil (5-FU)

Chemotherapy that blocks cancer cells from copying their DNA. Given slowly from a small pump you take home for about 24 hours.

Durvalumab

Only in the durvalumab version. An immunotherapy medicine that helps your immune system find and attack cancer cells. Given through a vein every 4 weeks.

How you get it

FLOT is given in an outpatient infusion clinic, usually through a port (a small device placed under the skin of the chest). Day 1 in the clinic takes about 5 to 6 hours, then you go home with a small pump that gives fluorouracil over about 24 hours. Each cycle is 14 days. Most people get 4 cycles before surgery and 4 cycles after, for 8 cycles in total. Many people get a white blood cell booster shot after each cycle. Your schedule may be different.

A typical cycle

Day 1

Blood tests and a check in with your team. Anti-nausea medicines, then docetaxel, oxaliplatin and leucovorin through your port. Durvalumab is given every other cycle in that version. Then the take-home fluorouracil pump is connected.

Days 1 to 2

The pump slowly gives fluorouracil at home for about 24 hours. You may feel tired or queasy and sensitive to cold.

Day 2

The pump is disconnected at the clinic or by a home nurse. Many people get a white blood cell booster shot on this day or soon after.

Days 3 to 14

Rest and recovery. Blood counts are often lowest around days 7 to 10, so infection risk is highest then. Diarrhea can also show up during this time.

Common side effects and what helps

• Low white blood cell counts, which raise the risk of serious infection. Wash hands often and stay away from people who are sick.
• Tingling or numbness in fingers, toes or around the mouth, often set off by cold. Wear gloves to reach into the fridge and skip icy drinks for a few days after treatment.
• Diarrhea. Drink plenty of fluids and start your diarrhea medicine as your team taught you.
• Tiredness, often strongest for several days after each cycle. Plan rest and accept help.
• Nausea and poor appetite. Take anti-nausea medicines on schedule and eat small meals often.
• Hair loss. It usually starts a few weeks after the first cycle and grows back after treatment ends.
• Mouth sores. Rinse often with a mild salt and baking soda rinse and use a soft toothbrush.
• Changes to nails, and swelling in the legs from docetaxel. Tell your team if you notice them.
• With durvalumab: the immune system can sometimes attack healthy organs. Report new rash, diarrhea, cough or extreme tiredness early.

Call your care team right away if you have

• A fever of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher, or chills
• Diarrhea 4 or more times a day above your normal, diarrhea that does not stop with your medicines, or diarrhea with fever
• Not able to keep fluids down, or feeling dizzy when you stand
• Chest pain, trouble breathing or swallowing, or a new cough (rarely, oxaliplatin can cause a throat squeeze feeling, or an allergic reaction during the infusion)
• Flushing, itching, chest tightness or back pain during an infusion (tell the nurse right away)
• Bleeding that will not stop, black stools or vomiting blood
• A problem with your pump, such as a leak, alarm or wet bandage
• Severe belly pain, or new swelling or pain in one leg

Good to know

• Infection is the biggest danger with FLOT. A fever during treatment is an emergency, even if you feel otherwise OK.
• You will take a steroid medicine around docetaxel treatment to help prevent allergic reactions and fluid buildup. Take it exactly as directed.
• Some people have a gene change (DPD deficiency) that makes fluorouracil much stronger. Ask whether testing is right for you.
• Nerve symptoms from oxaliplatin and docetaxel can build up over time. Tell your team about any trouble buttoning, writing or walking.
• Eating can be hard with stomach or esophagus cancer. A dietitian can help you keep up your weight and strength before surgery.
• Blood tests are done before every cycle, and scans are done before surgery to plan the operation.

At home

• Keep the pump in its carry case, keep it dry, and do not shower in a way that wets the tubing. Never pull on the line.
• Check your temperature if you feel unwell, warm or shaky, and keep a thermometer at home.
• Avoid cold drinks, cold food and cold air on your face for several days after each treatment.
• Drink about 8 to 10 cups of fluid a day unless your team told you otherwise.
• Keep diarrhea and anti-nausea medicines at home and know when to take them.
• If eating solid food is hard, try soft foods and protein shakes, and ask to see a dietitian.

Questions to ask

• How many cycles will I get before and after surgery?
• Will durvalumab be added to my plan, and why?
• Will I get a white blood cell booster shot after each cycle?
• Should I be tested for DPD deficiency before starting?
• Who disconnects my pump, and who do I call if it alarms at night?
• Can I see a dietitian to help me keep my weight up?

Stomach and esophagus cancer

Last updated: 2026-10-27. Medically reviewed by Veli Bakalov, MD, medical oncologist (October 2026). General education from Step by Step, the patient portal of HemeOncBuddy.