Comparing treatment and outcomes in advanced esophageal, gastroesophageal junction, and gastric adenocarcinomas: a population-based study

Marieke Pape; Pauline A J Vissers; Willemieke P M Dijksterhuis; David Bertwistle; Laura McDonald; Bianca Mostert; Sarah Derks; Irma M Oving; Rob H A Verhoeven; Hanneke W M van Laarhoven

doi:10.1177/17588359231162576

Comparing treatment and outcomes in advanced esophageal, gastroesophageal junction, and gastric adenocarcinomas: a population-based study

Ther Adv Med Oncol. 2023 Mar 21:15:17588359231162576. doi: 10.1177/17588359231162576. eCollection 2023.

Authors

Marieke Pape^{1

2

3}, Pauline A J Vissers^{1

4}, Willemieke P M Dijksterhuis^{1

2

3}, David Bertwistle⁵, Laura McDonald⁵, Bianca Mostert⁶, Sarah Derks^{7

8

9}, Irma M Oving¹⁰, Rob H A Verhoeven^{1

2

3}, Hanneke W M van Laarhoven^{11

3}

Affiliations

¹ Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
² Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, the Netherlands.
³ Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
⁴ Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
⁵ Worldwide Health Economics & Outcomes Research, Bristol-Myers Squibb, Uxbridge, UK.
⁶ Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
⁷ Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Oncology, Amsterdam, the Netherlands.
⁸ Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, the Netherlands.
⁹ Oncode Institute, Utrecht, The Netherlands.
¹⁰ Department of Medical Oncology, Ziekenhuisgroep Twente, Almelo, the Netherlands.
¹¹ Amsterdam UMC location University of Amsterdam, Medical Oncology, Meibergdreef 9, Amsterdam 1105 AZ, the Netherlands.

Abstract

Background: Treatment of advanced or metastatic esophageal adenocarcinoma (EAC) follows the guidelines for gastroesophageal junction adenocarcinoma (GEJC) and gastric adenocarcinoma (GAC), but patients with EAC are often excluded from clinical studies of GEJC/GAC.

Objectives: Here we describe treatment and survival of patients with advanced EAC, GEJC, and GAC to provide population-based evidence on distinctions and similarities between these populations.

Design: Retrospective cohort study of patients with unresectable advanced (cT4b) or metastatic (cM1) EAC, GEJC, or GAC (2015-2020) were selected from the Netherlands Cancer Registry.

Methods: Overall survival (OS) was assessed using Kaplan-Meier methods, log-rank tests, and multivariable Cox regression.

Results: In all, 7391 patients were included (EAC: n = 3346, GEJC: n = 1246, and GAC: n = 2798). Patients with EAC were more often males and more often had ⩾2 metastatic locations. First-line systemic therapy was received by 42%, 47%, and 36% of patients with EAC, GEJC, and GAC, respectively. Median OS was 5.0, 5.1, and 4.0 months for all patients with EAC, GEJC, and GAC, respectively (p < 0.001). Median OS from start of first-line therapy of patients with human epidermal growth factor receptor 2 (HER2)-negative adenocarcinomas was 7.6, 7.8, and 7.5 months (p = 0.12) and of patients with HER2-positive carcinoma receiving first-line trastuzumab-containing therapy was 11.0, 13.3, and 9.5 months (p = 0.37) in EAC, GEJC, and GAC, respectively. After multivariable adjustment, no difference in OS for patients with EAC, GEJC, and GAC was observed.

Conclusion: Despite differences in clinical characteristics and treatment strategies, survival between patients with advanced EAC, GEJC, and GAC was similar. We advocate that EAC patients should not be excluded from clinical trials for patients with molecularly similar GEJC/GAC.

Keywords: esophageal adenocarcinoma; gastric adenocarcinoma; gastroesophageal junction adenocarcinoma; overall survival; systemic therapy.