OBJECTIVES: Esophageal cancer (EC) is the eighth most common cancer and the sixth common cause of cancer-related deaths worldwide. It is associated with a poor prognosis having an 18% 5-year overall survival. This study examined treatment patterns and HCRU in patients who initiated first line (1L) or second line (2L) systemic therapy for squamous cell carcinoma (ESCC) with a focus on 2L patients.

METHODS: A retrospective, non-interventional study was conducted among 639 physicians in the US, Canada, France, Germany, Italy, Spain, UK, Japan, Korea, Taiwan and China between September and October 2018. Patient characteristics and treatment-related data were collected from the 3 most recent patient medical charts.

RESULTS: 1,049 ESCC patients were included (n=387 2L). The mean age was 65 years, 82% were male, 53% had gastroesophageal reflux disease, and 21% had Barrett’s Esophagus. Testing rates were: 51% for HER-2, 35% for MSI, and 28% for PD-L1.

59% of 2L patients were given systemic treatment and 41% best supportive care. Taxane monotherapy was preferred in Japan (62%), UK (50%), Germany (43%), Spain (40%) and Canada (40%). Most commonly reported grade 3-4 adverse events (AEs) for 2L patients were neutropenia (9%), fatigue (9%), nausea (8%), diarrhea (8%), and anorexia (8%). The rate of AE-related ER visits was 15% and hospitalizations was 13%, with a median length of stay among those with a hospitalization of 10.5 days. The percentage of 2L patients with an ECOG score 2-4 following treatment was 58%. Only 8% of patients went onto 3L; 38% of patients died after 2L, and 49% did not receive additional treatment at the time of data collection.

CONCLUSIONS: Effective options for 2L treatment of ESCC are limited, resulting in poor ECOG performance status and high mortality and adverse event rates. This suggests a high unmet need for 2L patients.