2250 - Survival in advanced oesophagogastric adenocarcinoma (OGA) improves with the use of multiple lines of therapy: results from an analysis of over 500 patients (pts)

Background

Palliative chemotherapy (CT) remains the primary mode of treatment for advanced OGA and is shown to improve survival in the 1st and 2nd line setting. We sought to evaluate the use of systemic therapy and assess survival outcomes for pts with advanced OGA treated at the Royal Marsden Hospital (RMH).

Methods

Retrospective analysis of consecutively treated pts receiving at least 1 cycle of CT for advanced OGA at RMH between April 2009 - Nov 2015.

Results

511 pts were identified; 75% male, 25% female; median age at diagnosis 66 yrs (range 24-90). Treatment intent at initial diagnosis was radical in 21% (with subsequent relapse) and palliative in 79%. There was no significant difference in median overall survival (OS) in the advanced setting between pts with relapsed disease after initial radical treatment and pts with metastatic disease at diagnosis (12.6 vs 11.3m; p = 0.10). OS was significantly improved for confirmed HER2+ve pts compared to HER2-ve (15.0 vs 11.9m; p = 0.02). OS was significantly improved in pts treated within a therapeutic clinical trial at any line of treatment compared with those who were not (13.5 vs 10.1m; p = 0.02). Survival was significantly correlated with number of treatment lines received (p 3 linesN511 (100%)200 (39%)70 (14%)15 (3%)TreatmentsTriplet 63% Doublet 33% Single 4%Triplet 12% Doublet 34% Single 54%Triplet 3% Doublet 37% Single 60%Clinical trial103 (20%)57 (29%)25 (36%)5 (33%)Median no. cycles633ORRCR 2% PR 47% SD 29%CR 0% PR 20%, SD 34%CR 0% PR 19% SD 24%PFS (m)5.53.01.8OS (m)11.5 (whole cohort)OS (m)8.3 (1^st line only received)14.0 (1^st + 2^nd line received)20.1 (1^st, 2^nd + 3^rd line received)33.0 (>3 lines received)

Conclusions

We have demonstrated the pattern of usage of systemic therapy for over 500 patients treated within a single UK oncology centre. Survival outcome remains poor for the majority of pts who have 1^st line CT only. Pts suitable for sequential CT have better outcomes and entry into clinical trials is associated with improved survival. There remains a need to define evidence-based therapies for the small but increasing proportion of pts suitable for treatment in the 3^rd line and beyond.

Clinical trial identification

Legal entity responsible for the study

Dr N Starling, Royal Marsden Hospital NHS Foundation Trust, Gastrointestinal medical oncology unit.

Funding

None

Disclosure

I. Chau: Sanofi Oncology, Eli Lilly, Bristol-Meyers Squibb, MSD, Bayer, Roche, Five Prime Therapeutics, Jansse, Gilag, Sanofi, Merck Serono, Novartis, Taiho, Pfizer, Amgen, Gilead. D. Cunningham: Amgen, AstraZeneca, Bayer, Celgene, Merrimack, Medimmune, Merck Serono, Sanofi All other authors have declared no conflicts of interest.