scholarly journals Treatment Patterns for Gastroesophageal Junction Adenocarcinoma in the United States

2020 ◽  
Vol 9 (11) ◽  
pp. 3495
Author(s):  
Bradford J. Kim ◽  
Yi-Ju Chiang ◽  
Prajnan Das ◽  
Bruce D. Minsky ◽  
Mariela A. Blum ◽  
...  
Keyword(s):  
United States ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
The United States ◽  
Treatment Patterns ◽  
Disease Stage ◽  
Gastroesophageal Junction Adenocarcinoma ◽  
Prospective Trials ◽  
Age Range

Despite the increasing incidence of gastroesophageal junction adenocarcinoma (GEJA), the optimal treatment strategy for the disease remains unknown. The objective of this study was to describe treatment patterns for GEJA in the United States. The National Cancer Database was searched to identify all patients who underwent resection of the lower esophagus, abdominal esophagus, and/or gastric cardia for GEJA between 2006 and 2016. Patients were grouped by clinical disease stage: early localized (L; T1-2N0), locally advanced (LA; T3-4N0), regional (R; T1-2N+), or regionally advanced (RA; T3-4N+). The search identified 28,852 GEJA patients. The dominant age range was 60–69 years (39%). Most patients were men (85%), and most were white (92%). Most L patients (69%) underwent upfront surgery, whereas most LA, R, and RA patients received neoadjuvant therapy (NAT; 86%, 80%, and 90%, respectively). Among patients who received NAT, 85% received chemoradiotherapy. Adjuvant therapy was relatively uncommon across all groups (15–20%). In the LA, R, and RA groups, overall survival was greater in patients who received NAT compared to upfront surgery (p < 0.001). With the exception of patients with early localized node-negative disease, most GEJA patients receive neoadjuvant chemoradiotherapy despite the lack of prospective trials reporting survival benefit over chemotherapy alone.

Treatment trends in gastroesophageal and gastric cancers in the United States.

2017 ◽  
Vol 35 (4_suppl) ◽  
pp. 136-136 ◽  
Author(s):  
Ali Mokdad ◽  
Amna Ali ◽  
Ibrahim Nassour ◽  
John C. Mansour ◽  
Sam C. Wang ◽  
...  
Keyword(s):  
United States ◽  
Metastatic Disease ◽  
Practice Patterns ◽  
Early Stage ◽  
Gastroesophageal Junction ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Multimodality Treatment ◽  
The United States ◽  
Distal Esophagus

136 Background: Randomized clinical trials reported in the last decade have helped define gastroesophageal junction (GEJ) and gastric cancer (GC) treatment. It is unclear, however, how practice patterns have evolved following these trials. This study explores the trends in treatment of GEJ and GC over the past decade in the United States. Methods: Patients with adenocarcinoma of the stomach and distal esophagus were identified in the National Cancer Database between 2006 and 2013. Tumor located in the distal esophagus and gastric cardia was denoted GEJ. Tumors distal to the cardia constituted GC. Tumors were categorized as early (Stage IA), locally advanced (IB-IIIC), and metastatic (IV). Detailed treatment was compared according to tumor stage and location. A time trend analysis was conducted. Results: A total of 120,729 patients (GEJ: 79,654 [66%], GC: 41,075 [34%]) were identified. Stage was similar in both groups (early: 12%, locally advanced: 55%, and metastatic: 33%). Overall, 73% of early GEJ and 74% of early GC underwent resection; of those, 43% and 12% were local excisions, respectively. Local excisions increased over time in both groups (annual odds ratio [OR] = 1.2; P < 0.01). In locally advanced GEJ, neoadjuvant chemoradiotherapy (CRT) increased among patients that received multimodality treatment (53% in 2006 to 73% in 2013; OR = 1.1, P < 0.01). In locally advanced GC, the use of neoadjuvant chemotherapy (CT) increased (5% to 20%; OR = 1.2, P < 0.01) as did perioperative CT (1% to 9%; OR = 1.3, P < 0.01) in lieu of adjuvant CRT (68% to 43%; OR = 0.9, P < 0.01). Multimodality treatment use remained stable over the study period in both groups (GEJ: 42%, GC: 47%). Among patients with metastatic disease, only 61% of GEJ and 40% of GC patients received CT, with 32% and 40%, respectively, not receiving any therapy at all. Conclusions: Practice patterns for GEJ and GC changed in the last decade with increasing adoption of neoadjuvant therapy in locally advanced disease and local excision of early stage cancers. Treatment for metastatic disease remains markedly underutilized, particularly GC.

scholarly journals U.S. prevalence of endocrine therapy–naïve locally advanced or metastatic breast cancer

2019 ◽  
Vol 26 (2) ◽  
Author(s):  
A. P. Nunes ◽  
C. Liang ◽  
W. J. Gradishar ◽  
T. Dalvi ◽  
J. Lewis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Metastatic Breast Cancer ◽  
Endocrine Therapy ◽  
Language Processing ◽  
Locally Advanced ◽  
Metastatic Breast ◽  
The United States ◽  
Disease Stage ◽  
Free Text

Background Variations in treatment choice, or late stage at first diagnosis, mean that, despite guideline recommendations, not all patients with hormone receptor (hr)–positive locally advanced or metastatic breast cancer (la/mbca) will have received endocrine therapy before disease progression. In the present study, we aimed to estimate the proportion of women with postmenopausal hr-positive la/mbca in the United States who are endocrine therapy-naïve.Methods Women in the Optum Electronic Health Record (ehr) database with a breast cancer (bca) diagnosis (January 2008–March 2015) were included. Patient and malignancy characteristics were identified using structured data fields and natural-language processing of free-text clinical notes. The proportion of women with postmenopausal hr-positive, human epidermal growth factor 2 (her2)–negative (or unknown) la/mbca who had not received prior endocrine therapy was determined. Results were extrapolated to the entire U.S. population using the U.S. National Cancer Institute’s Surveillance, Epidemiology, and End Results database. Results are presented descriptively.Results In the ehr database, 11,831 women with bca had discernible information on postmenopausal status, hr status, and disease stage. Of those women, 1923 (16.3%) had postmenopausal hr-positive, her2-negative (or unknown) la/mbca, and 70.7% of those 1923 patients (n = 1360) had not received prior endocrine therapy, accounting for 11.5% of the overall population. Extrapolating those estimates nationally suggests an annual incidence of 14,784 cases, and a 5-year limited duration prevalence of 50,638 cases.Conclusions A substantial proportion of women with postmenopausal hr-positive la/mbca in the United States could be endocrine therapy–naïve.

Real-world evidence of treatment patterns and pharmacy costs among patients with metastatic castration-resistant prostate cancer (mCRPC) in a managed care population in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19319-e19319
Author(s):  
Kelvin A. Moses ◽  
Katrine Wallace ◽  
Adrienne Landsteiner ◽  
Scott Bunner ◽  
Nicole Engel-Nitz ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Real World ◽  
Locally Advanced ◽  
The United States ◽  
Treatment Patterns ◽  
Administrative Claims ◽  
Castration Resistant Prostate Cancer ◽  
Real World Data ◽  
Entire Study

e19319 Background: Prostate cancer (PC) is the most common cancer among men in the United States. Once the disease progresses to mCRPC, initial castration modalities may not be sufficient. This real-world data study describes the treatment patterns and pharmacy costs of US-insured patients with mCRPC. Methods: Adult males in an administrative claims database who had ≥1 claim for PC (ICD-9: 185 or 233.4; ICD-10: C61 or D075), had undergone pharmacologic or surgical castration, and had a code for metastatic disease during the identification period were included in the analysis. A minimum of 6 months of continuous enrollment (CE) pre- and post-index date (first metastatic claim) was required. Patients with metastatic claims at baseline were excluded. Patients were followed until the earliest of death (unless prior to 6-month CE), end of study period, or disenrollment. Claims-based algorithms were used to identify locally advanced and distant mCRPC patients and lines of therapy (LOT). The entire study period (baseline period through follow-up) was January 2008-March 2018. Results: 3690 patients with mCRPC were identified, of which 3150 received at least one LOT; 85.4% had ≥1 LOT, 69.4% had ≥2 LOTs, and 50.7% had ≥3 LOTs following metastatic diagnosis (Table). The average duration of treatment was similar across groups: 83.8, 86.5, 71.7, and 70.2 days for LOTs 1–4, respectively. The five most common LOTs were leuprolide (36.6%), bicalutamide-leuprolide (6.6%), abiraterone (5.9%), bicalutamide (5.0%), and enzalutamide (4.7%). Mean monthly per-patient pharmacy costs increased with each LOT ($2683, $2654, $2911, $2924, $3611, for LOTs 1–5, respectively). Conclusions: This is the first study to examine treatment patterns and drug costs of patients with mCRPC. Given the large number of LOTs this population moves through and the increasing costs associated with each, the development of more efficacious novel therapies for use earlier in the metastatic treatment regimen to prolong life is warranted. [Table: see text]

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