Hospital volume and beyond first-line palliative systemic treatment in metastatic oesophagogastric adenocarcinoma: A population-based study

Willemieke P.M Dijksterhuis,Rob H.A Verhoeven,Marieke Pape,Marije Slingerland,Nadia Haj Mohammad,Judith De Vos-Geelen,Laurens V Beerepoot,Theo Van Voorthuizen,Geert-Jan Creemers,Valery E.P.P Lemmens,Martijn G.H Van Oijen,Hanneke W.M Van Laarhoven

doi:10.1016/j.ejca.2020.08.010

Abstract

BackgroundBeyond first-line palliative systemic treatment can be beneficial to selected oesophagogastric cancer patients, but experience with its administration may be limited and vary among hospitals. In a population-based study, we analysed the association between hospital systemic treatment volume and administration of beyond first-line treatment in oesophagogastric adenocarcinoma, as well as the effect on overall survival (OS). MethodsSynchronous metastatic oesophagogastric adenocarcinoma patients (2010–2017) were selected from the Netherlands Cancer Registry. Hospitals were categorised in volumes quartiles. The association between hospital systemic treatment volume and the use of beyond first-line treatment was assessed using trend and multivariable logistic regression analyses. OS was compared between hospitals with high and low beyond first-line treatment administration and treatment strategies using Kaplan–Meier curves with log-rank test and multivariable Cox proportional hazard regression. ResultsBeyond first-line treatment was administered in 606 of 2,466 patients who received first-line treatment, and increased from 20% to 31% between 2010 and 2017 (P < 0.001). The lowest hospital volumes were independently associated with lower beyond first-line treatment administration compared to the highest volume (OR 0.62, 95% CI 0.39–0.99; OR 0.67, 95% CI 0.48–0.95). Median OS was higher in all patients treated in hospitals with a high versus low beyond first-line treatment administration (7.9 versus 6.2 months, P < 0.001). Second-line paclitaxel/ramucirumab was administered most frequently and independently associated with longer OS compared to taxane monotherapy (HR 0.74, 95% CI 0.59–0.92). ConclusionHigher hospital volume was associated with increased beyond first-line treatment administration in oesophagogastric adenocarcinoma. Second-line paclitaxel/ramucirumab resulted in longer survival compared to taxane monotherapy.

Highlights

Life expectancy of patients with metastatic oesophagogastric cancer is poor [1]
Of all 2,466 patients who received first-line systemic treatment, second, third, fourth- and fifth-line treatment were administered in 25% (n Z 606), 4% (n Z 107), 1% (n Z 19) and 0.1% (n Z 3), respectively
Adjusted HRs of patients treated with second-line treatment in lower treatment volume hospitals (Q1, Q2 and Q3) compared to the highest volume (Q4) were 1.41, 1.56 and 1.15, respectively, this was only statistically significant in Q2 hospitals (Table 4). In this nationwide cohort of 2,466 patients with synchronous metastatic oesophagogastric adenocarcinoma who received first-line palliative systemic treatment, we observed an association between hospital volume and the probability of receiving beyond first-line treatment, and overall survival

Summary

Introduction

Life expectancy of patients with metastatic oesophagogastric cancer is poor [1]. Palliative systemic therapy aims to prolong survival while maintaining quality of life [2e5]. Median time from start of first-line systemic treatment to failure was only 4.6 months in a real-world patient cohort [6]. Single-agent chemotherapy such as irinotecan [7] or a taxane [8,9] have demonstrated activity in second line. A second-line regimen containing the VEGF inhibitor ramucirumab with or without a taxane has shown to have an additional survival benefit when administered for oesophagogastric adenocarcinoma [10,11]. Trials on third-line treatment are still scarce, increasing evidence confirms this could be beneficial in highly selected patients [12]

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Results

Conclusion