Introduction: With no licensed therapies for previously treated advanced GC until recently, little is known on how patients who have failed first-line chemotherapy are managed. We present real-world data on characteristics, treatments, and resource utilization for such patients in France.
Methods: Physicians who treat patients with advanced GC were asked to complete a web-based chart review detailing clinical and resource utilization data for 3 to 4 de-identified patients each. Regional quotas were used to provide a geographic distribution of physicians. Eligible patients were ≥ 18 years old, diagnosed between January 2007 and March 2012 with advanced GC, received first-line fluoropyrimidine + platinum, had ≥ 3 months of follow-up after first-line discontinuation, and had not participated in a clinical trial. Data were summarized descriptively, with cohorts based on second-line chemotherapy versus no further chemotherapy.
Results: From June to July 2013, 56 physicians provided data for 201 patients. Patients ’ mean age was 61 (±9.1) years and 76% were male. Patients were treated and followed in general hospitals (35%), university or regional hospitals (32%), specialized cancer hospitals (19%), or private clinics (14%). When initiating first-line chemotherapy, ECOG performance status (PS) was 19% 0, 61% 1, and 19% 2. The most common first-line regimens were 5-FU + oxaliplatin (24%), 5-FU + cisplatin (16%), and 5-FU + cisplatin + docetaxel (10%). The most common reasons for first-line chemotherapy discontinuation were completion of planned regimen (43%) and disease progression (39%). ECOG PS at first-line chemotherapy discontinuation was 7% 0, 46% 1, 36% 2, and 10% 3. A total of 55% of patients received second-line chemotherapy, and 68% of these patients had PS 0/1 at the start of second-line chemotherapy. The most common second-line regimens were 5-FU + irinotecan (37%), docetaxel (10%), 5-FU + oxaliplatin + leuocovorin (7%), 5-FU + irinotecan + leucovorin (6%), and capecitabine (6%). Among patients who received second-line chemotherapy, 18% received third-line chemotherapy. After first-line chemotherapy discontinuation, rates of supportive care for those with second-line versus those without further chemotherapy were: pain interventions, 50% versus 61%; anti-emetics, 39% versus 37%; nutritional support, 41% versus 42%; and transfusions, 19% versus 21%. After first-line chemotherapy discontinuation, rates of resource utilization for those with second-line versus those without further chemotherapy were: office visits (other than for chemotherapy administration), 63% versus 62%; emergency department visits, 37% versus 27%; inpatient hospitalization, 43% versus 40%; and hospice, 17% versus 18%. The most common contributing reasons for hospitalization were disease progression and palliative care; patients were most commonly treated within oncology wards.
Conclusion: In this study sample of advanced GC patients from France, slightly more than half of patients received second-line chemotherapy, but there was considerable variation in regimens. Rates of supportive care were similar between those with second-line chemotherapy and those without, except for of a lower rate of pain interventions in the chemotherapy cohort. Rates of resource utilization were similar, except for of a higher rate of emergency department visits in the chemotherapy cohort.
