OBJECTIVES : Esophageal cancer (EC) is the seventh most common cancer and the sixth common cause of cancer-related deaths worldwide. Those with metastatic disease have a poor prognosis, with an 8% 5-year overall survival. This study examined treatment patterns and healthcare resource utilization (HCRU) in patients who initiated first-line (1L) or second-line (2L) systemic therapy or received best supportive care (BSC) for esophageal squamous cell carcinoma (ESCC) with a focus on differences by Asian versus Western countries in 2L.

METHODS : A global retrospective, non-interventional study was conducted among 639 physicians from Asian (Japan, Korea, Taiwan and China) and Western (US, Canada, France, Germany, Italy, Spain, UK) countries between September-October 2018. Patient characteristics and treatment-related data were collected from the 3 most recent patient medical charts for patients on 1L, 2L or BSC. Chi-square or Fisher's exact tests were used.

RESULTS : 387 2L ESCC patients treated systemically or with BSC were profiled (West n=195; Asia n=192). The mean age was 63.4 years, and 81.4% were male with no differences by geography. Compared to Asia, Western patients were more likely to be current smokers (29.7% vs 13.5%; p=0.001), current alcohol users (31.8% vs 17.7%; p=0.002) and diagnosed as metastatic (58.5% vs 37.5%; p<0.001). At 2L, more Western patients received systemic treatment (West=63.6% vs Asia=52.6%; p=0.029) including a higher use of immunotherapy or targeted therapy (16.9% vs 3.0%; p=0.001). Taxane therapy use was similar across regions (West=42.7% vs Asia=48.5%, p=0.388), although lower rates were observed in the US (34.9%). HCRU for adverse events was lower in Western countries (e.g., ER visits=8.0% vs 22.2%; p<0.001). Following 2L systemic therapy 32.4% of patients died (West=33.1% vs Asia=31.7%; p=0.826).

CONCLUSIONS : There are some differences in baseline characteristics and treatment patterns across regions with Western patients having more high-risk characteristics than Asian patients, but patient survival was similar.