Perioperative Durvalumab in Gastric Cancer

To the Editor: Janjigian et al. (July 17 issue) 1 found better event-free survival outcomes with perioperative durvalumab plus FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) than with FLOT alone among participants with gastric cancer, but the results did not meet the prespecified significance threshold for overall survival (P=0.03 vs. required P<0.0001). The delayed separation in the overall survival curves (piecewise hazard ratio for death, 0.99 [0 to 12 months] vs. 0.67 [>12 months]) suggests uncertain long-term benefit. This statistical limitation necessitates caution before clinical adoption of perioperative durvalumab plus FLOT. Critical population exclusions undermine generalizability: participants with programmed death ligand 1 . . .