Toripalimab Plus FLOT in Locally Advanced Gastric Cancer

Inclusion Criteria:

• 70 ≥ Age ≥ 18 years regardless of gender

• Gastric adenocarcinoma confirmed by pathology

• no distant metastasis and resectable or potentially resectable evaluated by generalsurgery experts

• ECOG PS 0-1

• clinical stage T3/4 or N+ by AJCC 8.0

• PD-L1 CPS ≥1 (IHC 22C3 pharm Dx assay (Dako))

• expected lifespan over 3 months

• Adequate organ function: 1) without growth factor and blood component support in thefirst 2 weeks of enrollment; 2) Cardiac function: no heart disease or coronary heartdisease, grade 1-2; 3) liver function: TBIL ≤ 2ULN, AST ≤ 2.5 ULN, alt ≤ 2.5 ULNX 4Renal function: cr ≤ 1.25ULN, liver function: TBIL ≤ 2ULN, TBIL ≤ 2.5ULN, alt ≤ 2.5ULN, 4)renal function: cr ≤ 1.25ULN.

• blood pressure normal or controlled within the normal range by antihypertensivedrugs

• Diabetic patients were treated with hypoglycemic drugs to control fasting bloodglucose ≤ 8mmol/L

• Patients with positive hepatitis B surface antigen need to be tested forquantitative detection of hepatitis B DNA virus. HBV DNA should be less than theupper limit of the normal test value for patients with HBV infection.

• no other serious diseases conflicting with this study

• No history of other malignant tumors

• Women of childbearing age must be tested negative for blood pregnancy test within 7days before enrollment, and subjects of childbearing age must use appropriatecontraceptive measures during the trial and within 6 months after the trial

• agreement to participate in this study and signed the informed consent form

Exclusion Criteria:

• Pregnant or lactating women

• Suffered from severe infectious diseases within 4 weeks before entering the group

• Bronchial asthma requires intermittent use of bronchodilators or medicalintervention

• Due to the use of immunosuppressants before coexisting diseases and the dosage ofimmunosuppressants ≥ 10mg/, the oral dose of prednisone lasted for more than 2 weeks

• Clinically obvious cardio-cerebrovascular diseases, including, but not limited to,severe acute myocardial infarction, instability or severe angina pectoris, coronaryartery bypass surgery, congestive heart failure, ventricular arrhythmias requiringmedical intervention, left ventricular ejection fraction < 50%, stroke within 6months

• Allergic to any experimental drug and its excipients, or have a history of severeallergy, or are contraindications to experimental drugs

• Severe mental disorders

• Abnormal coagulation function (PT > 16s, APTT > 53s, TT > 21s Fib < 1.5g/L),bleeding tendency or undergoing thrombolysis or anticoagulation therapy

• Past or present pulmonary fibrosis, interstitial pneumonia, pneumoconiosis,radiation pneumonia, severe impairment of lung function, etc.

• Unable to swallow research drugs, chronic diarrhea (including but not limited toirritable bowel syndrome, Crohn's disease, ulcerative colitis) and intestinalobstruction affect drug use and absorption

• Have a history of immunodeficiency, including positive for HIV, or suffer from otheracquired, congenital immunodeficiency diseases, or have a history of organtransplant

• Other researchers evaluate those who do not meet the criteria for admission