Heterogeneity of first‐line palliative systemic treatment in synchronous metastatic esophagogastric cancer patients: A real‐world evidence study

Abstract

The optimal first‐line palliative systemic treatment strategy for metastatic esophagogastric cancer is not well defined. The aim of our study was to explore real‐world use of first‐line systemic treatment in esophagogastric cancer and assess the effect of treatment strategy on overall survival (OS), time to failure (TTF) of first‐line treatment and toxicity. We selected synchronous metastatic esophagogastric cancer patients treated with systemic therapy (2010–2016) from the nationwide Netherlands Cancer Registry (n = 2,204). Systemic treatment strategies were divided into monotherapy, doublet and triplet chemotherapy, and trastuzumab‐containing regimens. Data on OS were available for all patients, on TTF for patients diagnosed from 2010 to 2015 (n = 1,700), and on toxicity for patients diagnosed from 2010 to 2014 (n = 1,221). OS and TTF were analyzed using multivariable Cox regression, with adjustment for relevant tumor and patient characteristics. Up to 45 different systemic treatment regimens were found to be administered, with a median TTF of 4.6 and OS of 7.5 months. Most patients (45%) were treated with doublet chemotherapy; 34% received triplets, 10% monotherapy and 10% a trastuzumab‐containing regimen. The highest median OS was found in patients receiving a trastuzumab‐containing regimen (11.9 months). Triplet chemotherapy showed equal survival rates compared to doublets (OS: HR 0.92, 95%CI 0.83–1.02; TTF: HR 0.92, 95%CI 0.82–1.04) but significantly more grade 3–5 toxicity than doublets (33% vs. 21%, respectively). In conclusion, heterogeneity of first‐line palliative systemic treatment in metastatic esophagogastric cancer patients is striking. Based on our data, doublet chemotherapy is the preferred treatment strategy because of similar survival and less toxicity compared to triplets.

Impact of palliative therapies in metastatic esophageal cancer patients not receiving chemotherapy

“…In patients diagnosed with advanced esophageal cancer, a clinically significant proportion of patients decline did not receive chemotherapy and often opt for best supportive care[ 12 ]. Palliative chemotherapy in this population has been positively associated with an OS benefit, but grade 3-5 toxicity rates have been shown to be a relevant 33%-48% with platinum-based doublet regimens[ 26 , 27 ]. Other palliative modalities for esophageal cancer have historically included surgery, radiation therapy, nutritional optimization, relief of obstruction, pain control, or a combination of the above[ 28 ].…”

Increased assessment of HER2 in metastatic gastroesophageal cancer patients: a nationwide population-based cohort study

“…Details on systemic treatment regimen and TTF were available in patients who were diagnosed in 2015 (n = 445) or in a subset of Dutch hospitals between 2010 and 2014 (n = 1107), due to logistic reasons. The subset of hospitals was selected as a representative sample of all Dutch hospitals in terms of patient volume, and hospital type and location, as described earlier [31].…”

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

“…Patients were included if diagnosed during 2015e2017, or in a subset of Dutch hospitals during 2010e2014. This subset was selected because of logistic limitations, and regarded as a representative sample of all Dutch hospitals [6]. Two hospitals were excluded, because of missing details on treatment.…”

“…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]. Therefore, beyond first-line, i.e.…”