Presentation (CTI)

OBJECTIVES: Gastric and gastro‑oesophageal junction cancers (GC/GEJC) are aggressive malignancies with poor prognosis, particularly in the advanced or metastatic setting. In Ireland, the absence of a national screening programme contributes to late diagnosis and high mortality. In the absence of Irish‑specific clinical guidelines, treatment decisions are informed by European Society for Medical Oncology (ESMO) clinical practice guidelines, which outline multiple points across the treatment pathway where innovative therapies may be incorporated. However, these guidelines do not address whether patients are able to access such therapies in routine clinical practice. To assess whether Irish patients with advanced GC/GEJC have access to innovative therapies with demonstrated clinical benefit, as assessed using the ESMO Magnitude of Clinical Benefit Scale (MCBS), and to contextualise Irish access outcomes relative to selected European health technology assessment (HTA) systems.
METHODS: Innovative therapies for advanced GC/GEJC were identified based on published ESMO‑MCBS assessments. Irish reimbursement status was determined using publicly available reimbursement decisions. Reimbursement status for the same therapies was examined in England and the Netherlands using national HTA decisions.
RESULTS: Fifteen ESMO‑MCBS assessments were identified, corresponding to nine unique medicine-indication pairs. Only one therapy was ultimately reimbursed in Ireland. As a result, routine treatment options for advanced GC/GEJC in Ireland remain largely restricted to standard chemotherapy backbones, with minimal incorporation of innovative add‑on therapies. In contrast, six of the nine MCBS‑assessed therapies were reimbursed in at least one European comparator country.
CONCLUSIONS: Despite demonstrated clinical benefit and inclusion within European treatment guidelines, most innovative therapies for advanced GC/GEJC do not achieve reimbursed access in Ireland. This limited uptake constrains the real‑world treatment pathway for Irish patients and highlights a persistent gap between clinical value recognition and patient access.