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Adding immunotherapy before and after surgery cut deaths in early stomach cancer; nearly seven in ten patients were alive at three years.
MATTERHORN, trial NCT04592913 sponsored by AstraZeneca and reported in 2025, showed that adding durvalumab before and after surgery to perioperative FLOT chemotherapy cuts deaths in resectable stage II to IVA gastric and gastro-oesophageal junction adenocarcinoma. It randomised 948 patients, met its primary event-free survival endpoint, nearly tripled the pathologic complete response rate and showed an overall survival benefit at ESMO 2025, leading to FDA approval on 25 November 2025 as the first perioperative immunotherapy in gastric cancer, with benefit consistent across PD-L1 levels. OnCo links it to gastric cancer, PD-L1 as a target, durvalumab, FLOT, the perioperative, pCR and event-free survival terms and Florian Lordick. The trial had no chemotherapy-free arm, and whether FLOT can be de-escalated is the open question.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
957 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Event-free survivalprimary | FLOT + durvalumab | 474 | - | 0.71 | - | link |
| FLOT + placebo | 474 | - | ||||
| Overall survival | FLOT + durvalumab | 474 | - | 0.78 (0.63 to 0.96) | 0.021 | link |
| FLOT + placebo | 474 | - | ||||
| Pathologic complete response | FLOT + durvalumab | - | 19.2 percent | - | - | link |
| FLOT + placebo | - | 7.2 percent |
Shares Event-free / disease-free survival (EFS, DFS, iDFS, RFS), Pathologic complete response (pCR), Neoadjuvant / adjuvant / perioperative, Durvalumab.
Shares Surgery roadmap: radical operations → less surgery → no surgery when a drug has done the work, Neoadjuvant / adjuvant / perioperative, Durvalumab, AstraZeneca.
Shares Florian Lordick, Gastric & gastro-oesophageal junction cancer.
Shares PD-L1-high gastric cancer, Gastric & gastro-oesophageal junction cancer, Immune checkpoint inhibitors.
Shares Durvalumab, PD-L1, AstraZeneca, Immune checkpoint inhibitors.
Shares PD-L1-high gastric cancer, AstraZeneca, Gastric & gastro-oesophageal junction cancer.
Shares Durvalumab, AstraZeneca, Immune checkpoint inhibitors.
Shares Durvalumab, AstraZeneca, Immune checkpoint inhibitors.