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Journal of Gastrointestinal Cancer

, Volume 50, Issue 4, pp 780–793 | Cite as

Treatment Patterns Among Patients with Metastatic and/or Unresectable Gastric Cancer in Brazil

  • Fernando Meton de Alencar Camara Vieira
  • Ana Paula Ornellas de Souza Victorino
  • Daniel de Iracema Gomes Cubero
  • Carlos Augusto de Mendonça Beato
  • Eimy Minowa
  • Guilherme Silva Julian
  • Diego NovickEmail author
Original Research
  • 33 Downloads

Abstract

Purpose

In Brazil, patients with gastric cancer have not been systematically followed-up and evaluated, thus data regarding patterns of care and outcomes are scarce or missing. The objective of this study was to evaluate patterns of care of advanced gastric cancer in standard practice in Brazil.

Methods

This was an observational, multicenter, retrospective study, which included patients with metastatic and/or unresectable gastric cancer (MGC) who underwent at least one line of treatment.

Results

We analyzed data on 155 patients diagnosed with MGC, most are men (57.4%), with mean age of 61.9 years at diagnosis, with 99 (63.9%) from the public healthcare system and 56 (36.1%) from the private setting. Platinum- and/or fluoropyrimidine-containing regimens prevailed as first-line therapy, while irinotecan was the most used regimen in the second and in the third lines. More than 40% of patients underwent only one line of systemic therapy, of which around 40% either died during the treatment or went on to best supportive care (BSC) only. The remaining patients received further treatment lines. A fifth of the patients in the study died within two months after discontinuation of the first-line treatment. Adverse events, use of concomitant medications, support procedures, outpatient visits, and hospitalizations were reported for most patients, especially in the first and second lines of treatment and during exclusive BSC.

Conclusions

Survival during or after the first-line chemotherapy remains poor among patients with MGC. Adverse events and health resource use were common in the first and second lines of treatment and in exclusive BSC. These results suggest that there is space for improvement in the treatment of MGC in Brazil.

Keywords

Gastric cancer Metastatic/unresectable Treatment patterns Stomach neoplasm 

Notes

Acknowledgements

Some findings of this paper were presented at the 19th European ISPOR Congress 2016 as a poster presentation with partial results. This study was funded by the Eli Lilly and Company. The authors are grateful for the support of Carolina Santinho, Christiane Bueno, Eloisa de Sá Moreira, Gabriel Prolla, Luiz Fernando Andrade Feijó, Renata Eiras Martins, Estela Federal, and Mayara Piani and all site staff involved in the study.

Compliance with Ethical Standards

Conflict of Interest

Diego Novick is an employee of Eli Lilly and Company Inc.; Eimy Minowa and Guilherme Silva Julian are employees of Kantar Health. The remaining authors declare that they have no conflicts of interest relevant to the manuscript submission.

Financial Support

This study was sponsored by Eli Lilly and Company.

References

  1. 1.
    International Agency for Research on Cancer (IARC). Estimated cancer incidence, mortality, and prevalence worldwide in 2012. Lyon: GLOBOCAN; 2012. [Available from: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx Google Scholar
  2. 2.
    Instituto Nacional do Câncer (INCA). Estimativas 2014: INCA; 2014 [Available from: http://www.inca.gov.br/estimativa/2014/tabelaestados.asp?UF=BR.
  3. 3.
    Sierra MS, Cueva P, Bravo LE, Forman D. Stomach cancer burden in Central and South America. Cancer Epidemiol. 2016;44(Suppl 1):S62–73.CrossRefGoogle Scholar
  4. 4.
    Coordenação INdCJAGdS, Vigilância. dPe. Estimativa 2016: incidência de câncer no Brasil Rio de Janeiro. 2015 [Available from: http://www.inca.gov.br/bvscontrolecancer/publicacoes/edicao/Estimativa_2016.pdf.
  5. 5.
    Arregi MMU, Férrer DPC, de Assis ECV, de Paiva FDS, Sobral LBG, André NF, et al. Perfil clínico-epidemiológico das neoplasias de estômago atendidas no Hospital do Câncer do Instituto do Câncer do Ceará, no período 2000-2004. Rev Bras Cancerol. 2009;55(2):121–8.Google Scholar
  6. 6.
    Torpy JM, Lynm C, Glass RM. JAMA patient page. Stomach cancer. JAMA. 2010;303(17):1771.CrossRefGoogle Scholar
  7. 7.
    Cao W, Yang W, Lou G, Jiang J, Geng M, Xi W, et al. Phase II trial of infusional fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFOXIRI) as first-line treatment for advanced gastric cancer. Anti-Cancer Drugs. 2009;20(4):287–93.CrossRefGoogle Scholar
  8. 8.
    Cuyun Carter G, Kaltenboeck A, Ivanova J, Liepa AM, San Roman A, Koh M, et al. Treatment patterns in patients with advanced gastric cancer in Taiwan. Asia Pac J Clin Oncol. 2016;13:185–94.CrossRefGoogle Scholar
  9. 9.
    Koo DH, Ryu MH, Ryoo BY, Seo J, Lee MY, Chang HM, et al. Improving trends in survival of patients who receive chemotherapy for metastatic or recurrent gastric cancer: 12 years of experience at a single institution. Gastric Cancer. 2015;18(2):346–53.CrossRefGoogle Scholar
  10. 10.
    Karve S, Lorenzo M, Liepa AM, Hess LM, Kaye JA, Calingaert B. Treatment patterns, costs, and survival among Medicare-enrolled elderly patients diagnosed with advanced stage gastric cancer: analysis of a linked population-based cancer registry and administrative claims database. J Gastric Cancer. 2015;15(2):87–104.CrossRefGoogle Scholar
  11. 11.
    Cuyun Carter G, Kaltenboeck A, Ivanova J, Liepa AM, San Roman A, Koh M, et al. Real-world treatment patterns among patients with advanced gastric cancer in South Korea. Cancer Res Treat. 2016;49:578–87.CrossRefGoogle Scholar
  12. 12.
    Wang XQ, Terry PD, Yan H. Review of salt consumption and stomach cancer risk: epidemiological and biological evidence. World J Gastroenterol. 2009;15(18):2204–13.CrossRefGoogle Scholar
  13. 13.
    Nomura AM, Wilkens LR, Henderson BE, Epplein M, Kolonel LN. The association of cigarette smoking with gastric cancer: the multiethnic cohort study. Cancer Causes Control. 2012;23(1):51–8.CrossRefGoogle Scholar
  14. 14.
    Zilberstein B, Malheiros C, Lourenco LG, Kassab P, Jacob CE, Weston AC, et al. Brazilian consensus in gastric cancer: guidelines for gastric cancer in Brazil. Arq Bras Cir Dig. 2013;26(1):2–6.CrossRefGoogle Scholar
  15. 15.
    Smyth EC, Verheij M, Allum W, Cunningham D, Cervantes A, Arnold D, et al. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(suppl 5):v38–49.CrossRefGoogle Scholar
  16. 16.
    Bouche O, Raoul JL, Bonnetain F, Giovannini M, Etienne PL, Lledo G, et al. Randomized multicenter phase II trial of a biweekly regimen of fluorouracil and leucovorin (LV5FU2), LV5FU2 plus cisplatin, or LV5FU2 plus irinotecan in patients with previously untreated metastatic gastric cancer: a Federation Francophone de Cancerologie Digestive Group Study—FFCD 9803. J Clin Oncol. 2004;22(21):4319–28.CrossRefGoogle Scholar
  17. 17.
    Wagner AD, Unverzagt S, Grothe W, Kleber G, Grothey A, Haerting J, et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev 2010(3):CD004064.Google Scholar
  18. 18.
    Hess LM, Michael D, Mytelka DS, Beyrer J, Liepa AM, Nicol S. Chemotherapy treatment patterns, costs, and outcomes of patients with gastric cancer in the United States: a retrospective analysis of electronic medical record (EMR) and administrative claims data. Gastric Cancer. 2016;19(2):607–15.CrossRefGoogle Scholar
  19. 19.
    Brown J, Liepa A, Bapat B, Sleilaty G, Kaye J. Real-world treatment patterns of previously treated advanced gastric and gastroesophageal junction adenocarcinoma (GC) in France. Ann Oncol. 2015;26(Suppl 4):iv25.Google Scholar
  20. 20.
    National Comprehensive Cancer Network (NCCN). Gastric cancer [Available from: National Comprehensive Cancer Network].Google Scholar
  21. 21.
    Liepa AM, Brown J, Bapat B, Kaye JA. Real-world treatment patterns of previously treated advanced gastric and gastroesophageal junction adenocarcinoma (GC) in the United Kingdom (UK). J Clin Oncol. 2015;33(Suppl 3):abstract):184.CrossRefGoogle Scholar
  22. 22.
    Thuss-Patience PC, Kretzschmar A, Bichev D, Deist T, Hinke A, Breithaupt K, et al. Survival advantage for irinotecan versus best supportive care as second-line chemotherapy in gastric cancer—a randomised phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). Eur J Cancer. 2011;47(15):2306–14.CrossRefGoogle Scholar
  23. 23.
    Kang JH, Lee SI, Lim DH, Park KW, Oh SY, Kwon HC, et al. Salvage chemotherapy for pretreated gastric cancer: a randomized phase III trial comparing chemotherapy plus best supportive care with best supportive care alone. J Clin Oncol. 2012;30(13):1513–8.CrossRefGoogle Scholar
  24. 24.
    Hironaka S, Ueda S, Yasui H, Nishina T, Tsuda M, Tsumura T, et al. Randomized, open-label, phase III study comparing irinotecan with paclitaxel in patients with advanced gastric cancer without severe peritoneal metastasis after failure of prior combination chemotherapy using fluoropyrimidine plus platinum: WJOG 4007 trial. J Clin Oncol. 2013;31(35):4438–44.CrossRefGoogle Scholar
  25. 25.
    Sun J, Song Y, Wang Z, Chen X, Gao P, Xu Y, et al. Clinical significance of palliative gastrectomy on the survival of patients with incurable advanced gastric cancer: a systematic review and meta-analysis. BMC Cancer. 2013;13:577.CrossRefGoogle Scholar
  26. 26.
    Orditura M, Galizia G, Sforza V, Gambardella V, Fabozzi A, Laterza MM, et al. Treatment of gastric cancer. World J Gastroenterol. 2014;20(7):1635–49.CrossRefGoogle Scholar
  27. 27.
    Elimova E, Shiozaki H, Slack RS, Chen HC, Wadhwa R, Sudo K, et al. Early versus delayed therapy of advanced gastric cancer patients—does it make a difference? Oncology. 2015;89(4):215–20.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Fernando Meton de Alencar Camara Vieira
    • 1
  • Ana Paula Ornellas de Souza Victorino
    • 2
  • Daniel de Iracema Gomes Cubero
    • 3
  • Carlos Augusto de Mendonça Beato
    • 4
  • Eimy Minowa
    • 5
  • Guilherme Silva Julian
    • 5
  • Diego Novick
    • 6
    Email author
  1. 1.Instituto COI de Educação e PesquisaRio de JaneiroBrazil
  2. 2.Instituto Nacional de Câncer José Alencar Gomes da SilvaRio de JaneiroBrazil
  3. 3.Centro de Estudos e Pesquisas de Hematologia e Oncologia/FM ABCSanto AndréBrazil
  4. 4.Fundação Amaral CarvalhoJaúBrazil
  5. 5.Evidências—Kantar HealthSão PauloBrazil
  6. 6.Lilly Research CentreEli Lilly and CompanyWindleshamUK

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