A Comparison of Real-World Treatment Patterns and Clinical Outcomes in Patients Receiving First-Line Therapy for Unresec
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ORIGINAL RESEARCH
A Comparison of Real-World Treatment Patterns and Clinical Outcomes in Patients Receiving First-Line Therapy for Unresectable Advanced Gastric or Gastroesophageal Junction Cancer Versus Esophageal Adenocarcinomas Veena Shankaran
. Hong Xiao . David Bertwistle . Ying Zhang .
Min You . Pranav Abraham . Ian Chau Received: August 9, 2020 / Accepted: November 10, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Management of locally advanced, unresectable, or metastatic (adv/met) esophageal adenocarcinoma (EAC) follows clinical guidance for gastric cancer (GC) and gastroesophageal junction cancer (GEJC). However, evidence for these guidelines is based largely on patients with adv/met GC/GEJC, and generally excludes patients with EAC. It is currently unclear whether patients with adv/met GC/GEJC and adv/met EAC have similar demographics and clinical outcomes in realworld practice. Methods: Adult patients diagnosed with adv/ met GC/GEJC and adv/met EAC between January 1, 2011 and November 30, 2018 were identified (Flatiron Health database); patients
V. Shankaran (&) Division of Oncology, Department of Medicine, Seattle Cancer Care Alliance, Seattle, WA, USA e-mail: [email protected] H. Xiao Y. Zhang M. You P. Abraham Bristol Myers Squibb, Lawrenceville, NJ, USA D. Bertwistle Bristol Myers Squibb, Uxbridge, Middlesex, UK I. Chau Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital, Sutton, Surrey, UK
with confirmed human epidermal growth factor receptor 2 (HER2)-positive tumors were excluded, and index was date of adv/met diagnosis. Median overall survival (OS) from start of firstline therapy until death/censoring was estimated by the Kaplan–Meier method. Multivariable analysis (Cox proportional hazards) was conducted to identify factors associated with OS. Results: In total, 3052 patients were identified (adv/met GC/GEJC, n = 2083; adv/met EAC, n = 969). Patients with EAC were more likely to be male, have a history of smoking, have a higher body weight and body mass index, and were less likely to be Hispanic/Latino or Medicaid enrollees than patients with GC/GEJC. A similar proportion of patients with adv/met GC/GEJC (75%; n = 2326) and adv/met EAC (77%; n = 1573) received first-line therapy. Fluoropyrimidine plus platinum combinations were the most frequent first-line regimen in both groups (36%). Median OS was similar for patients with adv/met GC/GEJC and adv/met EAC (9.7 vs. 9.1 months, respectively; hazard ratio [95% confidence interval] 0.96 [0.87–1.06]; p = 0.4320). Conclusion: Despite minor differences in baseline demographics, clinical outcomes for patients with adv/met GC/GEJC and EAC are similar. This supports the inclusion of patients with adv/met EAC in clinical trials assessing adv/med GC/GEJC.
Adv Ther
Keywords: Esophageal adenocarcinoma; Gastric cancer; Gastroesophageal junction cancer Key Summary Points Why carry out this study? Clinical management of locally advanced, unresectable, or metastatic (adv/met) esophageal adenocarcinoma (EAC) generally follows the recommen
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