Real-World Treatment Patterns Among Patients with Advanced Gastric Cancer in Taiwan

Abstract

Introduction: This study explored second‐line treatment patterns, patient outcomes, and cancer‐related resource use of patients with metastatic and/or locally recurrent, unresectable gastric cancer (MGC), including cancer of the stomach and gastroesophageal junction (GEJ) in Taiwan. Methods: Charts of randomly selected patients were reviewed by 37 physicians to collect de‐identified data on MGC (diagnosed on or after January 1, 2009). Patients received platinum/fluoropyrimidine first‐line therapy followed by second‐line therapy or best supportive care (BSC), had no other primary cancer, and did not participate in clinical trials following MGC diagnosis. Patient characteristics and treatment patterns were summarized using descriptive statistics. Results: Of 122 patients, 62.3% were male with an average age of 59.8 years. 64.8% were not current or former smokers and 67.2% reported no alcohol consumption. The most common tumor sites were the fundus and corpus (44.3%). Metastatic sites most often occurred in the peritoneum (63.1%), lymph nodes (42.6%), and liver (33.6%). At MGC diagnosis, the mean Charlson comorbidity index was 1.0 (std dev = 1.1). The most common comorbidities were peptic ulcer disease (34.4%) and diabetes without chronic complications (20.5%). Most patients (64.8%) received second‐line treatment, while 35.2% received BSC only. Among those who received second‐line, ECOG performance status scores were 0 (2.5%), 1 (50.6%), and 2 (41.8%). 31.6% of patients in second‐line treatment received a fluoropyrimidine + a platinum agent (+/‐ leucovorin); with 31.6% and 7.6% of patients treated with single‐agent fluoropyrimidine and taxane, respectively. Second‐line treatment was primarily chosen according to physician experience (69.6%) and hospital guidelines/formulary (58.2%). During second‐line treatment, the most common treatment‐related symptom was nausea/vomiting (38.0%) and the most common disease‐related symptom was pain (51.9%). Antiemetics (74.7%), analgesics (68.4%) and diuretics (22.8%) were used as supportive care. Approximately half (53.2%) of second‐line patients had at least one inpatient hospitalization and the main reason for the majority of these inpatient hospitalizations was for chemotherapy infusion. Outpatient hospitalization (55.6%) and visits to the oncologist (90.1%) were common among second‐line patients. Conclusion: In Taiwan, most MGC patients received second‐line treatment, though regimens varied. Understanding patient and disease characteristics and treatment patterns will help identify unmet needs and inform future research.