OBJECTIVES: Treatment patterns and survival outcomes among real-world first-line (1L) treated un-resectable advanced recurrent or metastatic esophageal squamous cell carcinoma (ESCC) patients in the U.S. were evaluated.

METHODS: Patients diagnosed with esophageal cancer between 1/1/2012, and 12/31/2020, were identified in the Flatiron database, a US EMR database representing 265 oncology clinics. Both recurrent (i.e., post-resective surgery stage 1-3 with recurrent disease) and un-resectable denovo patients (i.e., metastatic stage 4) were identified. Descriptive statistics of patient demographics, clinical characteristics, and treatment patterns over the index and post-index periods were generated. Kaplan-Meier survival curves were used to estimate median overall survival (mOS) for both 1L treated and best supportive care (BSC) patients.

RESULTS: A total of 356 ESCC patients (58 recurrent, 298 denovo patients) were identified. 73% (n=259) received 1L chemotherapy, and 97 were untreated BSC. The treated ESCC patients’ mean age was 66.3 ± 9.2 years and were mostly male (69.5%) and white (56%). The most common 1st line regimen was carboplatin + paclitaxel (38%), followed by FOLFOX (24%). 32.4% of these 1L patients went on to second-line, and of these, 32.1% went on to third-line. Females were more likely than males to be on 1L carboplatin+paclitaxel (46% vs 34%) and more likely to move on to 2L (39% vs 29%). More recent index years (>2017) saw a shift toward fluoropyrimidine + platinum 1L use over taxane+ platinum (38% vs 22%). First-line ESCC patients had a mOS of 8.5 (7.6 - 10.1) months, whereas BSC patients had a mOS of 4.1 (3.0 - 5.2 ) months.

CONCLUSIONS: In this 1L ESCC patient population, mOS was 8.5 months, which was more than double the mOS of the untreated BSC patients of 4.1 months. Deploying more effective treatments in the 1L setting may extend mOS among treatment-eligible patients.