Real-world treatment patterns, healthcare resource use and clinical outcomes of patients receiving second line therapy for advanced or metastatic gastric cancer

Abstract

Background: Second-line (2 L) chemotherapies for advanced or metastatic gastric cancer have shown improved survival but there is no commonly accepted standard of care. This study examines real-world patient characteristics, treatment patterns, healthcare resource use (HCRU) and clinical outcomes in this setting. Methods: Retrospective chart reviews were performed at participating institutions from Australia, Canada, Italy and UK for adult patients receiving 2 L treatment for advanced/metastatic disease from January 2013 to July 2015. Data were collected for 12 months or until death. Results: Two hundred eighty patients were included, mean age was 60.9 years and 68.9% were male. Half (51.8%) received monotherapy in 2 L, of whom 69.0% received taxanes. Irinotecan monotherapy was common in Australia (30.0% of monotherapy patients) and Canada (43.8%), but infrequent in Italy and UK. Doublet chemotherapy was used in 36.4% of 2 L patients, most commonly fluoropyrimidine + irinotecan. Use of targeted therapies (trastuzumab, ramucirumab) was infrequent except in Italy. Estimated median real-world progression-free survival (rwPFS) and real-world overall survival (rwOS) from the time of 2 L treatment initiation was 3.09 (95% CI: 2.76-3.68) and 6.54 (5.29-7.76) months, respectively, and estimated 12-month rwPFS and rwOS rate was 8 and 26%, respectively. Only a minority (26.8%) of patients were hospitalized during the follow-up period, with the lowest hospitalization in Italy (16.7%). Laboratory and imaging tests were performed for 93.2 and 70.4%, respectively. Conclusions: About half of patients received monotherapy as 2 L chemotherapy for advanced/metastatic gastric cancer and a third received doublets. Real-world clinical outcomes for 2 L treatment are poor and HCRU is considerable.

A global perspective in second‐line treatment patterns for patients with advanced esophageal squamous cell carcinoma

“…Treatment of 2L patients varied by country and geography with docetaxel and other taxanes used most often and aligning with evidence of the effectiveness of these treatments 20,34,36 . The recent GENERATE study, a retrospective chart survey in Australia, Canada, Italy and UK, reported that monotherapy and combination therapies were both equally used to treat at 2L for patients with ESCC, with variations between and within therapy groupings by country (e.g., monotherapy use 45% in Italy and 63% in UK) 17,33,36,38,39 . In contrast to the present findings that most 2L patients received doublet chemotherapy at 1L, in the GENERATE study, while most patients received combination therapy, triplet therapy was predominant 17 .…”

“…The patient cohort identified, while differed somewhat by region, was comparable to the sociodemographic and clinical profile of 2L ESCC patients previously reported using different study design settings 17,32–35 . We note that previous research analyzing treatment outcomes in ESCC patients were predominantly from Asian populations 32,35,36 unlike the current findings, where almost equal number of patients were included from both Asian and Western regions.…”

“…Previous RCTs have reported 21%–58% of patients undergoing surgery 35,36,39 whereas in the present analysis, overall, 23.5% of ESCC patients underwent surgery, although patients receiving BSC at 2L were more likely to have undergone surgery than those on systemic therapy. This latter finding might be attributable to the older population of patients more prevalent in our analysis compared to other studies 17,36,38 …”

“…The short survival period and limited treatment strategies available for advanced ESCC (advESCC) has resulted in a significant unmet need in this patient population. Population‐level data are minimal and studies are often subject to selection bias 11,16,17 . The effect of novel and neoadjuvant therapies, as well as that of other treatments including surgery, chemotherapy, and radiotherapy for the patient population with advESCC remains unknown.…”

A case of effective disease control of advanced gastric cancer following ramucirumab plus FOLFIRI in second line treatment in clinical practice

“…(95% ДИ 3,81-5,52), назначение двухкомпонентных схем позволяет увеличить МОВ до 7,53 мес. (95% ДИ 6,41-8,74), однако статистичеcкой значимости различия не достигают [24].…”