Treatment Pattern for Advanced Gastric Cancer in Japan and Factors Associated with Sequential Treatment: A Retrospective Administrative Claims Database Study

Abstract

Introduction Clinical trials have proven the efficacy and safety of new therapies for advanced gastric cancer (AGC), but how those therapies are used in the real world is poorly described. Real-world treatment patterns of antitumor therapies and factors associated with overall therapy duration in patients with AGC in Japan were investigated. Methods This retrospective cohort study used a Japanese administrative claims database (June 2014 to September 2019). Patients with AGC who started the guideline-recommended first-line combination regimens with platinum and fluoropyrimidine agents between June 2015 and July 2019 were included. Cox regression analysis was performed to identify factors associated with overall therapy duration (first line to last administration of guideline-listed agent). Results Of the 10,581 patients included, the most common first-line combination regimen without trastuzumab was S-1 plus oxaliplatin (4327/9069 patients; 47.7%) and with trastuzumab was capecitabine plus cisplatin (608/1512 patients; 40.2%). Most common second- and third-line regimens were ramucirumab plus taxane (3650/5358 patients; 68.1%) and nivolumab (1229/2390 patients; 51.4%), respectively. Factors positively associated with longer overall therapy duration were: oral fluoropyrimidine in first line (hazard ratio [95% confidence interval]: 0.63 [0.57–0.69]); trastuzumab in any line (0.73 [0.68–0.78]); treatment at a designated cancer hospital (0.89 [0.84–0.94]); dietary consultation within 1 month before/after start of first line (0.92 [0.86–0.98]); and treatment at a surgical department (0.94 [0.89–0.99]). Negatively associated factors were: edema (1.21 [1.07–1.37]); physical therapy (1.21 [1.12–1.31]); nutritional intervention (1.21 [1.14–1.28]) within 1 month before/after start of first line; thrombosis (1.13 [1.04–1.23]); renal disease (1.11 [1.02–1.21]); age (1.07 [1.02–1.13]); and peritoneal metastasis/ascites (1.06 [1.01–1.13]). Conclusions In real-world treatment practice for AGC in Japan, therapy choice after the recommended first-line chemotherapy was consistent with guidelines. Factors associated with overall therapy duration were identified, which may assist in optimizing treatment sequence. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01931-3.

Role of reduction gastrectomy in patients with gastric cancer with a single non‐curable factor: Supplementary analysis of REGATTA trial

“…The impact of second-or third-line treatment has been recently demonstrated, especially in Asian countries. 7 The proportion of patients who received second-line treatment seems lower in patients with L-lesion and patients receiving distal gastrectomy in Korea. The second-line transition rates between the country and the treatment arm have heterogeneity, but it seems to have minimal impact on survival.…”

“…The impact of second‐ or third‐line treatment has been recently demonstrated, especially in Asian countries 7 . The proportion of patients who received second‐line treatment seems lower in patients with L‐lesion and patients receiving distal gastrectomy in Korea.…”

Short-term efficacy and influencing factors of conventional chemotherapy combined with irinotecan in patients with advanced gastric cancer

“…Therefore, the treatment effect of the observation group was better, and the treatment could inhibit the proliferation of tumor cells and improve the condition of patients in the observation group. Studies have shown that irinotecan can improve immunity[ 25 ]. There is evidence that the addition of irinotecan can improve the immune function, promote metabolism, accelerate protein synthesis, regulate gastrointestinal function, and improve the physical condition of the patients[ 26 ].…”

Updated Immunotherapy for Gastric Cancer

“…Indeed, subsequent therapy was reported to be associated with a better survival rate [ 100 , 101 ]. However, of 10,581 advanced gastric cancer cases who received palliative systemic therapy in Japan, only 2930 (22.5%) underwent third-line chemotherapy [ 102 , 103 ]. If patients who did not receive immunotherapy in first-line treatment are unable to receive third-line treatment due to a poor general condition, they might not be able to receive immunotherapy during the entire course of palliative chemotherapy.…”