Burden of Illness and Treatment Patterns of Adult Patients with Advanced or Metastatic Gastric/Gastroesophageal Junction Cancer: A Systematic Literature Review

OBJECTIVES: Gastric and gastroesophageal junction cancer (G/GEJC), represents the fifth most common malignancy and the fourth leading cause of cancer-related death worldwide. This study aimed to identify published evidence on treatment patterns, real-world clinical and economic outcomes, and humanistic burden in previously untreated, unresectable, locally advanced and/or metastatic G/GEJC patients.

METHODS: A systematic literature review was conducted following the PRISMA 2020 guideline. The MEDLINE, Embase, and Cochrane Library were searched electronically for articles on 24 June 2022, supplemented by hand searches of congress abstracts, health technology assessments, relevant regulatory documents, and treatment guidelines. Searches included all interventions regardless of regulatory approval and were limited to English language. Interventional or preclinical studies, case series, case reports, and editorial articles were excluded. Reporting focused on publications published since 2012, with large sample size (n≥150).

RESULTS: Of the 1721 identified publications, data from 53 publications were extracted and included in this review. Majority of the publications (n=49) reported data from single-country studies; 25 from Asian countries and 8 from the US. Treatment patterns were reported in 37 publications, with combinations of fluoropyrimidines and platinum being the most commonly used regimens. S-1 was almost exclusively used in Asian countries. Most studies (n=40) reported real-world clinical outcomes with an estimated median OS ranging from 6.4 to 18.9 months. Economic burden was reported in 5 studies which showed a significant financial impact of advanced G/GEJC on patients, caregivers and healthcare providers.

CONCLUSIONS: Across studies, patients with advanced or metastatic G/GEJC had poor survival outcomes. There is limited real-world data available on the humanistic burden of advanced G/GEJC. Due to the search timeframe, the identified studies did not capture real-world outcomes of recently approved immuno-oncology therapies.