OBJECTIVES: While recent advances in gastric cancer treatment have the potential to extend overall survival, patient reports of disease symptoms, treatment toxicities, and quality of life are critical outcome measures. This study sought to assess patient-reported symptoms in a real-world cancer treatment setting from 2014-2017 to serve as a comparator to patients receiving novel therapies after 2017.

METHODS: This retrospective, observational study utilized de-identified data from five Cancer Treatment Centers of America (CTCA). Adults (≥ 18 years) with gastric or gastroesophageal junction cancer who received full panel genome sequencing between 2014-2017 were included. Standard of care at CTCA is to provide electronically administered surveys of 17 common symptoms scored from 0-10 (0=not present, 10=the worst imaginable) to patients at every visit.

RESULTS: Among 39 patients included in analyses, average age at diagnosis was 51 years (SD=10.9), 49% were male, and 62% were metastatic at diagnosis. Seven (18%) patients had ARID1A, 6 (15%) had ERBB2, 4 (10%) had ERBB3, 2 (5%) had EGFR, 4 (10%) had KRAS, 5 (13%) had PIK3CA, and 18 (46%) had TP53 gene alterations. Fifteen patients had PD-L1 testing in 2017, and of those, 8 (53%) had expression >1%. The five most severe symptoms reported within 12 months of diagnosis were fatigue (mean score=6.1, SD=2.6), lack of appetite (mean=6.0, SD=3.4), bowel discomfort (mean=5.7, SD=3.2), disturbed sleep (mean=5.0, SD=3.3), and drowsiness (mean=4.9, SD=2.7).

CONCLUSIONS: This study highlights the most burdensome symptoms among gastric cancer patients with known gene alterations in a real-world setting, prior to the introduction of immune checkpoint inhibitor (ICI) and other novel therapies. As new drugs that target gene alterations and PD-L1 expression become available, further research is needed to assess impact of therapies on patient-reported outcomes.