Real-World Impact Of Recurrence On Overall Survival (OS) In Patients With Unresectable Locally Advanced (LA) Esophageal/Gastroesophageal Junction Cancer (EC/GEJC) Treated With Definitive Chemoradiotherapy (dCRT) In US Community Oncology Clinics
Author(s)
Adriana Valderrama, MBA, PhD1, Lisa Herms, MSc, PhD2, Karthik Ramakrishnan, MPH1, Junxin Shi, PhD2, Gregory Patton, MD2, Helen Latimer, MPH2, Sonal Bordia, MD1, Sujatha Nallapareddy, MD3;
1Merck & Co., Inc., Rahway, NJ, USA, 2Ontada, Boston, MA, USA, 3Rocky Mountain Cancer Centers, Aurora, CO, USA
1Merck & Co., Inc., Rahway, NJ, USA, 2Ontada, Boston, MA, USA, 3Rocky Mountain Cancer Centers, Aurora, CO, USA
Presentation Documents
OBJECTIVES: dCRT is the standard treatment for patients with LA EC/GEJC who are ineligible for surgery. However, outcomes with dCRT remain poor, with high recurrence and low survival rates. This study assessed the impact of recurrence on OS using real-world data.
METHODS: Recurrence and OS were assessed among LA EC/GEJC patients initiating dCRT within The US Oncology Network from January 2015 to June 2021, with follow-up until the last record or death by December 2022. Event-free survival (EFS) and OS were assessed using Kaplan-Meier methods; OS was also assessed using Cox proportional hazards models, adjusting for patient characteristics and recurrence status. Landmark analyses examined OS differences by recurrence status at each landmark.
RESULTS: Among 300 patients, 112 (37.3%) experienced recurrence. The subgroup with recurrence had similar characteristics to the overall population; median age was 72 years, with 76.8% male and 80.4% Caucasian. Stage III was the most common diagnosis (58.0%); most tumors were esophageal (67.0%). In the overall cohort, median (95% CI) EFS and OS (mOS) were 8.9 (7.7, 10.6) and 18.1 (13.3, 21.8) months, respectively. The adjusted hazard ratio (HR) (95% CI) indicated a higher risk of death with recurrence (5.9 [4.1, 8.4]). For those recurring within 6 months, landmark mOS was 7.1 (2.9, 13.2), compared to 21.0 (17.6, 44.8) for those who had not recurred (HR=2.9 [1.5, 5.5]). Similar patterns were observed at 12 months (8.5 [6.8, 12.0] vs. 41.5 [38.8, not reached; NR]; HR= 4.2 [2.1, 8.2]) and 18 months (5.6 [3.1,9.0] vs. NR [32.8, NR]; HR= 5.7 [2.3, 14.4]).
CONCLUSIONS: This real-world study demonstrated that patients without recurrence at key landmark points had longer mOS than those who had recurred. Longer time to recurrence was associated with better survival, yet high recurrence rates persisted. Extending time to recurrence could improve long-term outcomes, highlighting an unmet need for effective early-stage therapies.
METHODS: Recurrence and OS were assessed among LA EC/GEJC patients initiating dCRT within The US Oncology Network from January 2015 to June 2021, with follow-up until the last record or death by December 2022. Event-free survival (EFS) and OS were assessed using Kaplan-Meier methods; OS was also assessed using Cox proportional hazards models, adjusting for patient characteristics and recurrence status. Landmark analyses examined OS differences by recurrence status at each landmark.
RESULTS: Among 300 patients, 112 (37.3%) experienced recurrence. The subgroup with recurrence had similar characteristics to the overall population; median age was 72 years, with 76.8% male and 80.4% Caucasian. Stage III was the most common diagnosis (58.0%); most tumors were esophageal (67.0%). In the overall cohort, median (95% CI) EFS and OS (mOS) were 8.9 (7.7, 10.6) and 18.1 (13.3, 21.8) months, respectively. The adjusted hazard ratio (HR) (95% CI) indicated a higher risk of death with recurrence (5.9 [4.1, 8.4]). For those recurring within 6 months, landmark mOS was 7.1 (2.9, 13.2), compared to 21.0 (17.6, 44.8) for those who had not recurred (HR=2.9 [1.5, 5.5]). Similar patterns were observed at 12 months (8.5 [6.8, 12.0] vs. 41.5 [38.8, not reached; NR]; HR= 4.2 [2.1, 8.2]) and 18 months (5.6 [3.1,9.0] vs. NR [32.8, NR]; HR= 5.7 [2.3, 14.4]).
CONCLUSIONS: This real-world study demonstrated that patients without recurrence at key landmark points had longer mOS than those who had recurred. Longer time to recurrence was associated with better survival, yet high recurrence rates persisted. Extending time to recurrence could improve long-term outcomes, highlighting an unmet need for effective early-stage therapies.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
RWD35
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
SDC: Gastrointestinal Disorders, STA: Multiple/Other Specialized Treatments