%0 Journal Article
%T Real-World Outcomes and Factors Associated With the Second-Line
Treatment of Patients With Gastric, Gastroesophageal Junction, or Esophageal
Adenocarcinoma
%A Afsaneh Barzi
%A Astra M. Liepa
%A Joseph Chao
%A Julie Beyrer
%A Lisa M. Hess
%A Tomoko Sugihara
%A Yajun E. Zhu
%J Archive of "Cancer Control : Journal of the Moffitt Cancer Center".
%D 2019
%R 10.1177/1073274819847642
%X This retrospective observational study was designed to evaluate overall survival in a real-world patient population and to identify predictive factors associated with receipt of second-line therapy. A retrospective analysis of electronic medical records (Flatiron Health, New York) was conducted among patients initiating first-line therapy from January 1, 2013, through April 30, 2018. Eligible patients were diagnosed with advanced gastric, gastroesophageal junction, or esophageal adenocarcinoma and ¡Ý18 years of age at the time of treatment initiation. Patients alive 45 days after discontinuation of first-line therapy were considered potentially eligible for continued therapy and were categorized into those who received and those who did not receive second-line therapy. Survival analyses were conducted using Kaplan-Meier method and log-rank test without adjusting for any baseline covariates. Factors associated with further treatment were evaluated using logistic regression. A total of 3850 patients met eligibility criteria. Among the 2516 patients available to receive second-line therapy, 1515 (60.2%) received second-line therapy and 1001 (39.8%) did not receive further therapy. Among those potentially eligible to receive second-line therapy, median survival was 15.4 months (95% confidence interval [CI]: 14.6-16.0) from initiation of first-line therapy for those who received second-line therapy and 10.0 months (95% CI: 9.3-10.7) for those who did not. Longer duration of first-line therapy (¡Ý169 vs ¡Ü84 days), HER2-positive tumors, initially diagnosed with stage IV disease, less weight loss during first-line therapy, and younger age were associated with receipt of second-line therapy (all P < .001). Longer survival was associated with multiple lines of therapy; however, these results should be interpreted with caution, and no causal relationship can be inferred
%K chemotherapy
%K decision-making
%K patient care
%K survival
%K health services research
%K gastroesophageal adenocarcinoma
%U https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6503607/