Objectives: Systematic review assessing survival outcomes in Asian and Western populations with treatment-experienced advanced oesophageal carcinoma (OC).

Methods: Comprehensive searches in MEDLINE, MEDLINE In-Process, Embase, Cochrane Library and conference proceedings were conducted (2006–2019) by two independent reviewers. Clinical trials and observational studies reporting outcomes in Asian or Western adult patients with advanced, metastatic or recurrent unresectable OC after prior therapies were included. This was supplemented by a pragmatic search for recent studies evaluating these two populations.

Results: Twenty studies reported outcomes for oesophageal squamous cell carcinoma (OSCC) patients receiving second-line therapy (Asian=18; Western=2). Most studies evaluated taxane-based regimens alone or in combination with other agents. Overall survival (OS) was comparable between Asian and Western populations with OSCC (median[range]: 7.5[5.1-10.9] versus 7.4[6.0-8.7] months, respectively) with a mean one-year survival rate of 21.1% in Asian and 27.9% in Western patients. Poorer OS was observed for Western patients with oesophageal adenocarcinoma (OADC; 5.6[4.0-7.2] months) compared to OSCC; no data was identified for Asian patients with OADC. To supplement this evidence, two recent randomised controlled trials were assessed, which evaluated immunotherapies versus chemotherapy in advanced OC, providing stratified results by geographical location. KEYNOTE-181 reported only hazard ratios for key subgroups of interest, which showed greater impact for immunotherapies (pembrolizumab) in OSCC versus OADC patients and for Asian versus non-Asian patients; however, absolute outcomes were not reported, limiting the comparison. ATTRACTION-3 also identified a beneficial impact for immunotherapies (nivolumab) across OSCC populations; although few non-Asian patients were enrolled, increasing uncertainty, confidence intervals were shown to overlap with the Asian population.

Conclusions: The systematic review showed that OS was comparable between Asian and Western patients with advanced OSCC. This was supported by evidence from recently published studies directly comparing Asian versus non-Asian populations.