Why carry out this study?
|
Clinical management of locally advanced, unresectable, or metastatic (adv/met) esophageal adenocarcinoma (EAC) generally follows the recommendations for adv/met gastric cancer (GC) and adv/met gastroesophageal junction cancer (GEJC). |
Few studies have assessed whether patients receiving first-line therapy for adv/met GC/GEJC and adv/met EAC have similar demographics, treatment patterns, and clinical outcomes in routine clinical practice. |
What was learned from the study?
|
In this real-world analysis of electronic health records, there were some minor underlying demographic differences between patients with adv/met GC/GEJC and adv/met EAC; patients with EAC were more likely to be male, have a history of smoking, have a higher body weight and body mass index, and were less likely to be Hispanic/Latino or Medicaid enrollees. |
Both groups of patients appeared to receive comparable treatment in real-world practice, with fluoropyrimidine plus platinum combinations the most frequent first-line regimen in both groups; over one-third of patients in each group (36%) received these agents. |
Median OS was broadly similar for those who were diagnosed with adv/met GC/GEJC (9.7 months) and those with adv/met EAC (9.1 months); Cox regression indicated that survival was not associated with the primary site of disease (GC/GEJC vs. EAC). |
Time to next treatment and progression-free survival were also similar between patients with adv/met GC/GEJC and those with adv/met EAC. |
In real-world clinical practice, patients with EAC are treated similarly to those with adv/met GC/GEJC, and have similar outcomes; patients with adv/met EAC should therefore be included in clinical trials of adv/met GC/GEJC. |
Digital Features
Introduction
Methods
Data Source and Patient Selection
Study Variables and Outcomes
Statistical Analyses
Results
Baseline Demographics and Disease Characteristics
All (n = 3052) | Adv/met GC/GEJC (n = 2083) | Adv/met EAC (n = 969) | p value | |
---|---|---|---|---|
Median (range) age at index, years | 66 (24–85) | 66 (25–85) | 66 (24–85) | 0.2900 |
Age group at index, n (%) | 0.4564 | |||
≥ 65 years | 1655 (54.2) | 1120 (53.8) | 535 (55.2) | |
< 65 years | 1397 (45.8) | 963 (46.2) | 434 (44.8) | |
Sex, n (%) | < 0.0001 | |||
Male | 2263 (74.1) | 1393 (66.9) | 870 (89.8) | |
Female | 789 (25.9) | 690 (33.1) | 99 (10.2) | |
Practice type, n (%) | 0.5313 | |||
Community | 2909 (95.3) | 1982 (95.2) | 927 (95.7) | |
Academic | 143 (4.7) | 101 (4.8) | 42 (4.3) | |
Benefit plan type, n (%) | ||||
Commercial health plan | 1072 (35.1) | 728 (34.9) | 344 (35.5) | 0.7666 |
Medicare | 719 (23.6) | 498 (23.9) | 221 (22.8) | 0.5047 |
Medicaid | 99 (3.2) | 78 (3.7) | 21 (2.2) | 0.022 |
Other government program | 96 (3.1) | 65 (3.1) | 31 (3.2) | 0.9077 |
Patient assistance program | 30 (1.0) | 21 (1.0) | 9 (0.9) | 0.8361 |
Self-pay | 13 (0.4) | 11 (0.5) | 2 (0.2) | 0.204 |
Other | 563 (18.4) | 390 (18.7) | 173 (17.9) | 0.5643 |
Missing | 976 (32.0) | 649 (31.2) | 327 (33.7) | 0.1534 |
Geographic region, n (%) | < 0.0001 | |||
South | 1094 (35.8) | 778 (37.3) | 316 (32.6) | |
Northeast | 639 (20.9) | 414 (19.9) | 225 (23.2) | |
West | 642 (21.0) | 458 (22.0) | 184 (19.0) | |
Midwest | 453 (14.8) | 261 (12.5) | 192 (19.8) | |
Other | 55 (1.8) | 47 (2.3) | 8 (0.8) | |
Missing | 169 (5.5) | 125 (6.0) | 44 (4.5) | |
Race, n (%) | < 0.0001 | |||
White | 1913 (62.7) | 1177 (56.5) | 736 (76.0) | |
Black or African American | 208 (6.8) | 181 (8.7) | 27 (2.8) | |
Asian | 138 (4.5) | 129 (6.2) | 9 (0.9) | |
Other | 423 (13.9) | 335 (16.1) | 88 (9.1) | |
Missing | 370 (12.1) | 261 (12.5) | 109 (11.2) | |
Ethnicity, n (%) | < 0.0001 | |||
Hispanic or Latino | 313 (10.3) | 275 (13.2) | 38 (3.9) | |
Other/missing | 2739 (89.7) | 1808 (86.8) | 931 (96.1) | |
Smoking status, n (%) | < 0.0001 | |||
History of smoking | 1871 (61.3) | 1162 (55.8) | 709 (73.2) | |
No history of smoking | 1082 (35.5) | 849 (40.8) | 233 (24.0) | |
Missing | 99 (3.2) | 72 (3.5) | 27 (2.8) | |
Weight at index, lb | n = 2258 | n = 1501 | n = 757 | < 0.0001 |
Mean (SD) | 173.9 (45.3) | 167.6 (44.3) | 186.2 (44.7) | |
Median (range) | 169 (68.6–385.4) | 162 (68.6–385.4) | 182 (84.0–380.0) | |
BMI at index, kg/m2 | n = 2247 | n = 1493 | n = 754 | < 0.0001 |
Mean (SD) | 26.7 (6.1) | 26.2 (5.8) | 27.9 (6.5) | |
Median (range) | 26.2 (12.2–67.3) | 25.6 (12.2–51.2) | 27.2 (14.4–67.3) | |
Median (range) follow-up from index, mo | 7.8 (0.1–95.1) | 7.9 (0.2–95.1) | 7.7 (0.1–80.9) | 0.6105 |
Stage at initial diagnosis, n (%) | 0.9345 | |||
Stage I–III | 835 (27.4) | 573 (27.5) | 262 (27.0) | |
Stage IV | 1967 (64.4) | 1338 (64.2) | 629 (64.9) | |
Missing | 250 (8.2) | 172 (8.3) | 78 (8.0) | |
ECOG PS at start of 1L, n (%) | 0.1969 | |||
Not available | 1123 (48.3) | 774 (49.2) | 349 (46.3) | |
Available | 1203 (51.7) | 799 (50.8) | 404 (53.7) | 0.7225 |
0–1 | 1003 (83.4) | 664 (83.1) | 339 (83.9) | |
≥ 2 | 200 (16.6) | 135 (16.9) | 65 (16.1) |
Treatment Patterns
All (n = 3052) | Adv/met GC/GEJC (n = 2083) | Adv/met EAC (n = 969) | |
---|---|---|---|
Received 1L therapy, n (%) | 2326 (76.2) | 1573 (75.5) | 753 (77.7) |
Median (range) time from index to 1L, months | 1.1 (0–89.9) | 1.1 (0–89.9) | 1.1 (0–63.0) |
Median (range) duration of 1L, months | 2.1 (0.03–34.2) | 2.3 (0.03–34.2) | 1.9 (0.03–25.1) |
Regimen classes in 1L, n (%) | |||
Fluoropyrimidine + platinum | 828 (35.6) | 568 (36.1) | 260 (34.5) |
Taxane plus platinum | 454 (19.5) | 229 (14.6) | 225 (29.9) |
ECFa | 276 (11.9) | 215 (13.7) | 61 (8.1) |
DCFa | 263 (11.3) | 183 (11.6) | 80 (10.6) |
Fluoropyrimidine monotherapy | 201 (8.6) | 167 (10.6) | 34 (4.5) |
Fluorouracil + irinotecan + leucovorin | 42 (1.8) | 30 (1.9) | 12 (1.6) |
Taxane monotherapy | 37 (1.6) | 19 (1.2) | 18 (2.4) |
Other | 225 (9.7) | 162 (10.3) | 63 (8.4) |
Clinical Outcomes
All (n = 2326) | Adv/met GC/GEJC (n = 1573) | Adv/met EAC (n = 753) | |
---|---|---|---|
Median (95% CI) OS from start of 1L, months | 9.5 (9.0–9.9) | 9.7 (9.0–10.2) | 9.1 (8.4–9.9) |
Survival probability at 12 months (SD) | 38.8 (1.1) | 40.4 (1.3) | 35.7 (1.9) |
Survival probability at 24 months (SD) | 14.8 (0.9) | 15.5 (1.1) | 13.3 (1.5) |
Median (95% CI) TTNT from start of 1L, months | 5.3 (5.1–5.6) | 5.4 (5.1–5.7) | 5.1 (4.7–5.6) |
Median (95% CI) real-world progression from start of 1L, months | 5.1 (4.9–5.4) | 5.3 (5.0–5.6) | 4.8 (4.4–5.3) |
Comparator | Reference | HR (95% CI) | p value |
---|---|---|---|
Primary site of disease | |||
GC/GEJC | EAC | 0.96 (0.87–1.06) | 0.4320 |
Age group | |||
≥ 65 years | < 65 years | 1.04 (0.93–1.16) | 0.5151 |
Practice type | |||
Academic | Community | 2.31 (0.43–12.47) | 0.3306 |
Sex | |||
Male | Female | 1.10 (0.98–1.23) | 0.1175 |
Race | |||
Asian | White | 0.82 (0.64–1.05) | 0.1203 |
Black | 1.01 (0.84–1.22) | 0.9119 | |
Other | 0.77 (0.66–0.90) | 0.0008 | |
Missing | 1.43 (1.22–1.68) | < 0.0001 | |
US region | |||
Midwest | South | 0.97 (0.78–1.20) | 0.7829 |
Northeast | 0.79 (0.65–0.96) | 0.0163 | |
West | 0.83 (0.68–1.01) | 0.0612 | |
Other | 0.41 (0.18–0.92) | 0.0294 | |
Missing | 0.64 (0.12–3.30) | 0.5909 | |
Insurance type | |||
Multiple types | Commercial plan | 1.03 (0.87–1.21) | 0.7323 |
Medicare | 0.91 (0.74–1.11) | 0.3465 | |
Medicaid | 1.03 (0.72–1.48) | 0.8549 | |
Other | 1.06 (0.91–1.24) | 0.4334 | |
Missing | 0.98 (0.86–1.11) | 0.7404 | |
Disease stage at initial diagnosis | |||
Stage I–III | Stage IV | 0.64 (0.54–0.75) | < 0.0001 |
Unknown | 0.67 (0.51–0.89) | 0.0053 | |
Smoking status | |||
History of smoking | No history of smoking | 0.98 (0.83–1.14) | 0.7513 |
Unknown | 1.39 (0.93–2.07) | 0.1129 | |
ECOG PS at start of 1L | |||
ECOG PS 2–4 | ECOG PS 0–1 | 2.63 (2.01–3.45) | < 0.0001 |
Missing | 1.29 (1.10–1.51) | 0.0013 | |
Practice type × time | |||
Academic | Community | 0.99 (0.99–1.00) | 0.1044 |
US region × time | |||
Midwest | South | 1.00 (1.00–1.00) | 0.8082 |
Northeast | 1.00 (1.00–1.00) | 0.0577 | |
West | 1.00 (1.00–1.00) | 0.0647 | |
Other | 1.00 (1.00–1.00) | 0.8856 | |
Missing | 1.01 (1.00–1.01) | 0.1507 | |
Disease stage at initial diagnosis × time | |||
Stage I–III | Stage IV | 1.00 (1.00–1.00) | 0.4347 |
Unknown | 1.00 (1.00–1.00) | 0.0284 | |
Smoking status × time | |||
History of smoking | No history of smoking | 1.00 (1.00–1.00) | 0.9752 |
Unknown | 1.00 (1.00–1.00) | 0.0872 | |
ECOG PS at start of 1L × time | |||
2–4 | 0–1 | 1.00 (1.00–1.00) | 0.0017 |
Missing | 1.00 (1.00–1.00) | 0.0032 |