OBJECTIVES: Esophageal cancer (EC) is the seventh most common cancer and the sixth most common cause of cancer-related deaths worldwide. It is associated with a poor prognosis having an 18% 5-year overall survival rate. This study examined treatment patterns and healthcare resource utilization (HRU) in patients who initiated first-line (1L) systemic therapy for advanced esophageal squamous cell carcinoma (ESCC) across geographies.

METHODS: A 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 (September-October 2018). Patient characteristics and treatment-related data were collected from the 3-4 most recent patient medical charts for 1L systemic treatment or best supportive care (BSC).

RESULTS: 1,049 ESCC patients were included (Asia=40.2%; West=59.8%), with a mean age of 62.9±10.6 years and 82.7% male. 81.8% (n=858) received 1L systemic treatment (Asia=71.1%; West=89.0%). The five most common 1L treatment regimens were cisplatin + 5-FU (27.4%), carboplatin + paclitaxel (8.4%), FOLFOX (8.0%), 5-FU (+leucovorin) (6.6%), and carboplatin + 5-FU (5.9%), although differences were observed by geography. Rates of adverse event [AE]-related emergency room visits and hospitalizations for patients on systemic treatment were 14.5% and 12.9%, respectively, with increased rates for Asian compared to Western patients (P=0.006). The percentage of 1L patients with an ECOG performance status (PS) 2-4 following treatment was 36.1% (Asia=35.3%; West=36.4%; P=0.690). Response to 1L treatment and outcomes following 1L treatment (at the time of data collection) were similar by geography, with 36.2% progressing to a next line of therapy and 13.2% who died.

CONCLUSIONS: Treatment options for 1L therapy in ESCC vary by region. Variation by Asian and Western countries were observed for AE-related HRU but not for PS following treatment, treatment response, or outcomes. Burden of disease for these 1L patients exists regardless of geography suggesting a need for improved treatments.