EP.WE.832A silver lining in the dark COVID cloud: Total neoadjuvant chemotherapy results in complete pathological response in locally advanced distal gastric adenocarcinoma

Abstract Aims Perioperative oncological therapies resulting in complete pathological response diffuse type distal gastric adenocarcinoma are extremely rare. We report the first case of regression a patient with locally advanced (CT3N2M0) who received “total neoadjuvant” chemotherapy FLOT due to COVID pandemic. Methods & Results A 73-year-old male was diagnosed cT3N2M0 adenocarcinoma. He 4 cycles neoadjuvant as planned immune checkpoint inhibitor Durvlumab and interval PET-CT showed massive reduction 18F-FDG avidity. However, his surgery postponed COVID-19 pandemic given excellent adjuvant were into preoperative setting. Subsequent close zero uptake he proceeded laparoscopic radical subtotal gastrectomy D2 lymphadenectomy. Histopathology resected specimen demonstrated no evidence residual malignancy, (TRG1a, ypT0N0 R0). Conclusions Amidst dark cloud there silver lining for one patient, delayed total (8 cycles). This should generate randomised controlled trials comparing current standard care regimens investigating utilisation investigations such CT-PET monitoring therapy, guiding optimal timing surgical resection.