1458P - Real-world treatment patterns of unresectable advanced or synchronous metastatic esophageal squamous cell cancer in a Western population

Background

Phase III studies on treatment of unresectable advanced or synchronous metastatic esophageal squamous cell carcinoma (ESCC) are lacking, and data on primary treatment in a Western, real-world setting is limited. The aim of our study was to explore real-world use of systemic treatment regimens and overall survival (OS) in patients with unresectable advanced or metastatic ESCC.

Methods

From the nationwide Netherlands Cancer Registry, we selected patients with unresectable advanced (cT_4b-cM₀) or synchronous metastatic (cT_all-cM₁) ESCC (including junction tumors) diagnosed in 2015-2017. OS was analyzed using the Kaplan-Meier method with Log-Rank test. Subgroup analyses were performed in patients with unresectable locoregional tumor (cT4_b-cM₀; LR-ESCC), patients with head and neck lymph node metastasis only (HN-ESCC) and other distant metastases (DM-ESCC).

Results

We identified 579 patients. Eighteen percent of patients (n=105) presented with LR-ESCC, 18% of patients (n=105) with HN-ESCC and 64% (n=369) with DM-ESCC. Surgical resection with or without chemoradiotherapy of the primary tumor was performed in 8% of LR-ESCC (n=8), 10% of HN-ESCC (n=10) and 2% of DM-ESCC patients (n=6). Patients with LR-ESCC (33%) and HN-ESCC (30%) more often received chemoradiotherapy than patients with DM-ESCC (6%) and less often received first-line systemic treatment (LR-ESCC: 6%, HN-ESCC: 12% and DM-ESCC: 24%). Radiotherapy on primary tumor differed between groups (LR-ESCC: 22%, HN-ESCC: 27% and DM-ESCC 33%). A third of all patients did not receive surgery, chemoradiotherapy, systemic therapy or radiotherapy (LR-ESCC: 34%, HN-ESCC: 24% and DM-ESCC: 36%). Median OS for all patients was 5.6 months. Median OS significantly differed between patients with LR-ESCC (6.5 months)_, HN-ESCC (10.5 months)and DM-ESCC (4.4 months; p<0.01). Multivariable analyses confirmed a better OS for patients with HN-ESCC compared to DM-ESCC (adjusted HR 0.63, 95% CI 0.48-0.82).

Conclusions

Primary treatment and OS were different in patients with LR-ESCC, HN-ESCC and DM-ESCC. A third of all patients did not receive surgery, chemoradiotherapy, systemic therapy or radiotherapy.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Netherlands Comprehensive Cancer Organisation (IKNL).

Funding

Bristol Myers Squibb.

Disclosure

J. de vos-Geelen: Research grant/Funding (institution), non-financial support: Servier. H.W.M. van Laarhoven: Advisory/Consultancy, Research grant/Funding (institution): BMS; Advisory/Consultancy, Research grant/Funding (institution): Lilly; Advisory/Consultancy, Research grant/Funding (institution): MSD; Advisory/Consultancy, Research grant/Funding (institution): Nordic Pharma; Advisory/Consultancy: Novartis; Advisory/Consultancy, Research grant/Funding (institution): Servier; Research grant/Funding (institution): Bayer; Research grant/Funding (institution): Celgene; Research grant/Funding (institution): Janssen; Research grant/Funding (institution): Philips; Research grant/Funding (institution): Roche. R.H. Verhoeven: Research grant/Funding (institution): BMS; Research grant/Funding (institution): Roche. All other authors have declared no conflicts of interest.