Abstract
BackgroundSecond-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.MethodsRetrospective 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.ResultsTwo 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.ConclusionsAbout 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.
Highlights
Second-line (2 L) chemotherapies for advanced or metastatic gastric cancer have shown improved survival but there is no commonly accepted standard of care
Baseline characteristics and 1 L treatment Overall, 280 patients were included in the study: 34 from Australia (12.2%, from 6 sites), 100 from Canada (37.5%, from 6 sites), 84 from Italy (30.0%, from 8 sites), and 62 from the United Kingdom (UK) (22.1%, from 5 sites)
Three-quarters (76.1%) of patients had undergone human epidermal growth factor receptor 2 (HER2) testing, of whom approximately one in five (22.0%) tested positive, and the addition of the antiHER2 agent trastuzumab to the 1 L chemotherapy regimen was reported for 65.2% of these patients
Summary
Second-line (2 L) chemotherapies for advanced or metastatic gastric cancer have shown improved survival but there is no commonly accepted standard of care. It is estimated that about 1 million people worldwide will be diagnosed with gastric cancer in 2018 [1]. The prognosis for gastric cancer is generally poor Because it is asymptomatic in the early stages, more than half of gastric adenocarcinomas, which comprise 80–85% of gastric cancers, are diagnosed at an advanced. Systemic therapy remains the mainstay of treatment for patients with locally advanced and metastatic disease, and has been shown to improve survival, organ function and performance status compared with best supportive care (BSC) [4]. Trastuzumab and ramucirumab, are approved in a few countries for the treatment of advanced or metastatic gastric cancer
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