Gastric Cancer

, Volume 21, Issue 5, pp 738–744 | Cite as

Predictors of heterogeneity in the first-line treatment of patients with advanced/metastatic gastric cancer in the U.S.

  • Thomas Abrams
  • Lisa M. Hess
  • Yajun Emily Zhu
  • William Schelman
  • Astra M. Liepa
  • Charles Fuchs
Original Article



Patients with metastatic gastric cancer have a poor prognosis (5-year survival of less than 10%). This study was designed to describe the treatment patterns of patients with gastric cancer and to understand the factors associated with treatment choices to inform evidence-based care.


A retrospective observational study was conducted using two real-world databases to describe treatment trends and to quantify variability in treatment patterns of patients diagnosed with advanced/metastatic gastric cancer between 1/1/2007 and 9/30/2014 in the U.S. Heterogeneity was measured by the Herfindahl–Hirschman Index (HHI). Predictors (baseline clinical, treatment, and demographic variables) of treatment regimen choice were evaluated using logistic regression.


A total of 5772 patients with advanced/metastatic gastric cancer were included in this study [5044 from claims data and 728 from electronic medical records (EMR)]. Of the 5044 from claims data, 2457 had evidence of metastatic disease at diagnosis. Only the fluorouracil + oxaliplatin regimen exceeded 10% utilization in the first-line setting [claims metastatic (12.1%), claims advanced (8.2%), and EMR metastatic (16.6%) cohorts]. The HHI demonstrated extreme heterogeneity (0.14 for first-line therapy and 0.13 for second-line therapy). Patient age and geographic region of residence were significantly associated with treatment choice across all three cohorts in the first-line setting (p < 0.05).


Treatment of patients with gastric cancer was highly variable. Despite the availability of treatment guidelines, there is a lack of consistent treatment patterns. There is a need to improve evidence-based care for patients with gastric cancer.


Population characteristics Stomach neoplasms Drug therapy Antineoplastic agents 



This study was an unfunded research project conducted with the material support in the form of employee time and data resources by Eli Lilly and Company.

Compliance with ethical standards

Conflict of interest

LMH, YEZ, WS, and AML are employees of Eli Lilly and Company.

Ethical standards

This study was deemed exempt from Institutional Review Board review in accordance with the US Code of Federal Regulations [45CFR46.101(b)] as these data do not contain any variables that could identify an individual subject either directly or indirectly.


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Thomas Abrams
    • 1
  • Lisa M. Hess
    • 2
  • Yajun Emily Zhu
    • 2
  • William Schelman
    • 3
  • Astra M. Liepa
    • 2
  • Charles Fuchs
    • 4
  1. 1.Dana-Farber Cancer InstituteHarvard Medical SchoolBostonUSA
  2. 2.Eli Lilly and Company, Global Patient Outcomes and Real World EvidenceCorporate CenterIndianapolisUSA
  3. 3.Eli Lilly and CompanyUS Medical AffairsIndianapolisUSA
  4. 4.Yale Cancer CenterNew HavenUSA

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