Real-World Treatment Patterns and Outcomes Amongst Patients with Resectable Gastric and Gastroesophageal Junction Cancer in the United States

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BACKGROUND: Resectable gastric and gastroesophageal junction cancer (GC/GEJC) treatment patterns in the real-world are poorly described. This study described real-world perioperative treatment and outcomes for patients in the US with resectable GC/GEJC. METHODS: Data from the Flatiron Health Enhanced Datamart were analyzed for adult patients diagnosed with resectable GC/GEJC between 1 January 2016 and 1 January 2023. The primary objective was to describe perioperative treatments (neoadjuvant only, adjuvant only, both). Secondary objectives included real-world event-free survival (rwEFS) and real-world overall survival (rwOS). RESULTS: Data from 1717 patients (901/816 with GC/GEJC) were included. Median age of patients with GC/GEJC was 68.0/69.0 years, 62.4%/83.3% were male, and 97.3%/96.7% had adenocarcinoma, respectively. For GC/GEJC, 71.1%/47.9% underwent surgery, of which 15.6%/70.1% received neoadjuvant treatment only, 26.4%/5.6% received adjuvant treatment only, 25.0%/17.4% received both, and 33.1%/6.9% received no perioperative treatment, respectively. For GC, the most frequent neoadjuvant treatment was FLOT (43.0% neoadjuvant only; 53.8% both) and the most frequent adjuvant treatments were chemoradiotherapy (39.6% adjuvant only) and FLOT (43.1% both). For GEJC, chemoradiotherapy was the most frequent neoadjuvant (66.4% neoadjuvant only; 67.6% both) and adjuvant only (54.5%) treatment. When patients received both, the most frequent adjuvant treatment was nivolumab (45.6%). For GC/GEJC, median rwEFS (95% CI) was 29.1 (24.7-38.7)/20.8 (17.4-23.7) months for patients who had planned or cancelled surgery and 11.3 (9.6-13.5)/12.7 (11.6-15.4) months for patients without planned surgery. Median rwOS (95% CI) was 50.9 (43.7-62.4)/38.6 (31.4-47.2) months for patients who had planned or cancelled surgery and 15.4 (13.1-18.6)/21.0 (17.6-22.6) months for patients without planned surgery. CONCLUSIONS: Real-world data showed lower use of perioperative treatments for resectable GC/GEJC than expected. rwEFS and rwOS remain poor. Optimization of perioperative treatments is needed to improve long-term outcomes.

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