Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 21, 2020; 26(39): 6027-6036
Published online Oct 21, 2020. doi: 10.3748/wjg.v26.i39.6027
Real-world treatment attrition rates in advanced esophagogastric cancer
Erica S Tsang, Howard J Lim, Daniel J Renouf, Janine M Davies, Jonathan M Loree, Sharlene Gill
Erica S Tsang, Howard J Lim, Daniel J Renouf, Janine M Davies, Jonathan M Loree, Sharlene Gill, Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
Erica S Tsang, Howard J Lim, Daniel J Renouf, Janine M Davies, Jonathan M Loree, Sharlene Gill, Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
Author contributions: Tsang ES and Gill S were responsible for conception and design, collection and assembly of data, and data analysis and interpretation; all authors contributed to manuscript writing and provided final approval of the manuscript.
Institutional review board statement: This study was reviewed and approved by Systemic Therapy - Vancouver (BC Cancer), REB number H19-01865.
Conflict-of-interest statement: All authors have no any conflicts of interest.
Data sharing statement: No additional data.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sharlene Gill, MD, Professor, Department of Medicine, BC Cancer, 600 West 10th Avenue, Vancouver V5Z 4E6, Canada. sgill@bccancer.bc.ca
Received: May 10, 2020
Peer-review started: May 10, 2020
First decision: June 13, 2020
Revised: June 24, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: October 21, 2020
Processing time: 164 Days and 10.3 Hours
ARTICLE HIGHLIGHTS
Research background

Over the last decade, multiple agents have demonstrated efficacy for advanced esophagogastric cancer (EGC).

Research motivation

Despite the availability of later lines of therapy, there remains limited real-world data about the treatment attrition rates between lines of therapy.

Research objectives

We aimed to characterize the use and attrition rates between lines of therapy for patients with advanced EGC.

Research methods

We identified patients who received at least one cycle of chemotherapy for advanced EGC between July 1, 2017 and July 31, 2018 across six regional centers in British Columbia, Canada. Clinicopathologic, treatment, and outcomes data were extracted.

Research results

Of 245 patients who received at least one line of therapy, median age was 66 years (IQR 58.2-72.3) and 186 (76%) were male, Eastern Cooperative Oncology Group (ECOG) performance status 0/1 (80%), gastric vs GEJ (36% vs 64%). Histologies included adenocarcinoma (78%), squamous cell carcinoma (8%), and signet ring (14%), with 31% HER2 positive. Seventy-two percent presented with de novo disease, and 25% had received previous chemoradiation. There was a high level of treatment attrition, with patients receiving only one line of therapy (n = 122, 50%), two lines (n = 83, 34%), three lines (n = 34, 14%), and four lines (n = 6, 2%). Kaplan-Meier analysis demonstrated improved survival with increasing lines of therapy (median overall survival 7.7 vs 16.6 vs 22.8 vs 40.4 mo, P < 0.05). On multivariable Cox regression, improved survival was associated with better baseline ECOG and increased lines of therapy (P < 0.05).

Research conclusions

The steep attrition rates between therapies highlight the unmet need for more efficacious early-line treatment options for patients with advanced EGC.

Research perspectives

This real-world analysis demonstrating such steep attrition rates highlights the unmet need for more efficacious early-line treatment options.