Real-world Treatment Patterns and Clinical Outcomes Across Lines of Therapy in Patients With Advanced/Metastatic Gastric or Gastroesophageal Junction Cancer

Le, Dung T.; Ott, Patrick A.; Korytowsky, Beata; Le, Hannah; Le, Trong Kim; Zhang, Ying; Maglinte, Gregory A.; Abraham, Pranav; Patel, Dhiren; Shangguan, Tong; Chau, Ian

doi:10.1016/j.clcc.2019.09.001

Cited by 18 publications

(15 citation statements)

References 18 publications

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“…28 Second, there is evidence that the clinically meaningful benefit (such as objective response rate and progression-free survival) of subsequent SACTs decreases as the number of lines of prior SACT increases. [34][35][36][37][38] It is Table 2. The proposed standard dataset (top row) comprises the minimum data to be collected regarding the current disease status (columns 1-4) and anti-cancer therapy (columns 5-9) that would help determine the line of therapy (LoT, column 10).…”

Section: A Proposed Systematic and Comprehensive Framework To Determine Lot Terminology And Definitionsmentioning

confidence: 99%

Determining lines of therapy in patients with solid cancers: a proposed new systematic and comprehensive framework

Saini

Twelves

2021

Br J Cancer

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The complexity of neoplasia and its treatment are a challenge to the formulation of general criteria that are applicable across solid cancers. Determining the number of prior lines of therapy (LoT) is critically important for optimising future treatment, conducting medication audits, and assessing eligibility for clinical trial enrolment. Currently, however, no accepted set of criteria or definitions exists to enumerate LoT. In this article, we seek to open a dialogue to address this challenge by proposing a systematic and comprehensive framework to determine LoT uniformly across solid malignancies. First, key terms, including LoT and ‘clinical progression of disease’ are defined. Next, we clarify which therapies should be assigned a LoT, and why. Finally, we propose reporting LoT in a novel and standardised format as LoT N (CLoT + PLoT), where CLoT is the number of systemic anti-cancer therapies (SACT) administered with curative intent and/or in the early setting, PLoT is the number of SACT given with palliative intent and/or in the advanced setting, and N is the sum of CLoT and PLoT. As a next step, the cancer research community should develop and adopt standardised guidelines for enumerating LoT in a uniform manner.

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Section: A Proposed Systematic and Comprehensive Framework To Determine Lot Terminology And Definitionsmentioning

confidence: 99%

Determining lines of therapy in patients with solid cancers: a proposed new systematic and comprehensive framework

Saini

Twelves

2021

Br J Cancer

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“…Notably, the presence of two or more metastatic sites in each patient has been demonstrated to be an independent predictor of poor prognosis [19], but these data were unavailable in the Flatiron electronic health record dataset. Lines of therapy (and the treatment regimens used in each line) are determined algorithmically in line with previous studies of real-world outcomes in patients with adv/met GC/GEJC [25,26]; however, their accuracy cannot be confirmed, and reasons for discontinuation are unknown. Furthermore, data on prior surgeries are unavailable; prior surgery would have obvious implications on peri-and postoperative treatment selection.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Real-World Treatment Patterns and Outcomes in Patients Receiving Second-Line Therapy for Advanced/Metastatic Esophageal Squamous Cell Carcinoma

et al. 2020

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Introduction: Currently available second-line (2L) therapies for advanced/metastatic esophageal squamous cell carcinoma (adv/met ESCC) include the taxanes paclitaxel and docetaxel. In clinical trials, such therapies have provided only modest improvements in survival. Few studies have assessed outcomes in routine clinical practice in the USA. We compared realworld clinical outcomes in the US for patients receiving taxane or non-taxane 2L therapy for adv/met ESCC. Methods: The Flatiron Health database was used to identify patients diagnosed with adv/ met ESCC (1 January 2011-31 January 2019) who received 2L therapy; index date was date of adv/met diagnosis. Baseline variables and treatment regimens received were identified. Overall survival (OS; 2L start until death or last recorded medical activity) and duration of therapy (DoT; start of 2L therapy until last administration date of 2L therapy) in patients receiving taxane vs. non-taxane-based therapies in the 2L setting were estimated by Kaplan-Meier method. Results: There were no clear differences in baseline characteristics between patients who received 2L taxane therapy (n = 37) and 2L nontaxane therapy (n = 49). Median (95% CI) 2L OS was significantly longer with 2L taxanes (7.3 [5.9-11.5] months) vs. 2L non-taxanes (5.1 [2.9-7.6] months); median (95% CI) 2L DoT was 2.1 (1.8-3.0) months vs. 3.3 (2.6-6.7) months, respectively. Conclusion: Survival was generally poor in patients receiving 2L therapy for adv/met ESCC and was longer in patients receiving 2L taxanes than 2L non-taxane therapy. Efficacious, tolerable therapies for ESCC in the 2L setting are urgently needed.

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“…Nevertheless, the prognosis of patients with advanced GC with standard therapy remains dismal worldwide, with a median overall survival (OS) of 8 to 12 months, 5,6 and a 5-year OS reaching 5%. 7,8 Therefore, alternative means were sought to improve outcomes.…”

Section: Introductionmentioning

confidence: 99%

<p><em>MET</em> Inhibitors for the Treatment of Gastric Cancer: What’s Their Potential?</p>

Darsa¹,

Sayed²,

Abdel‐Rahman³

2020

JEP

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Gastric cancer remains a disease with a dismal prognosis. Extensive efforts to find targetable disease drivers in gastric cancer were implemented to improve patient outcomes. Beyond anti-HER2 therapy, MET pathway seems to be culprit of cancer invasiveness with MET-overexpressing tumors having poorer prognosis. Tyrosine kinase inhibitors targeting the HGF/MET pathway were studied in MET-positive gastric cancer, but no substantial benefit was proven. Some patients responded in early phase trials but later developed resistance. Others failed to show any benefit at all. Etiologies of resistance may entail inappropriate patient selection with a lack of MET detection standardization, tumor alternative pathways, variable MET amplification, and genetic variation. Optimizing MET detection techniques and better understanding the MET pathway, as well as tumor bypass mechanisms, are an absolute need to devise means to overcome resistance using targeted therapy alone, or in combination with other synergistic agents to improve outcomes of patients with MET-positive GC.

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Real-world Treatment Patterns and Clinical Outcomes Across Lines of Therapy in Patients With Advanced/Metastatic Gastric or Gastroesophageal Junction Cancer

Cited by 18 publications

References 18 publications

Determining lines of therapy in patients with solid cancers: a proposed new systematic and comprehensive framework

Determining lines of therapy in patients with solid cancers: a proposed new systematic and comprehensive framework

Real-World Treatment Patterns and Outcomes in Patients Receiving Second-Line Therapy for Advanced/Metastatic Esophageal Squamous Cell Carcinoma

<p><em>MET</em> Inhibitors for the Treatment of Gastric Cancer: What’s Their Potential?</p>

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