1. Developing real-world comparators for clinical trials in chemotherapy-refractory patients with gastric cancer or gastroesophageal junction cancer
- Author
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Hannah Le, Ying Zhang, Tong Shangguan, Dhiren Patel, Dung T. Le, Pranav Abraham, Patrick A. Ott, Beata Korytowsky, Teresa Sanchez, T. Kim Le, G. Maglinte, Melissa Laurie, and Ian Chau
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Esophageal Neoplasms ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Placebo ,Cohort Studies ,Placebos ,03 medical and health sciences ,Antineoplastic Agents, Immunological ,0302 clinical medicine ,Refractory ,Stomach Neoplasms ,Surgical oncology ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,Clinical Trials as Topic ,Chemotherapy ,business.industry ,Gastroenterology ,Correction ,Cancer ,General Medicine ,Middle Aged ,medicine.disease ,Clinical trial ,Nivolumab ,Oncology ,030220 oncology & carcinogenesis ,Female ,Esophagogastric Junction ,business ,Abdominal surgery - Abstract
Background There are few third-line or later (3L+) treatment options for advanced/metastatic (adv/met) gastric cancer/gastroesophageal junction cancers (GC/GEJC). 3L+ Nivolumab demonstrated encouraging results in Asian patients in the ATTRACTION-2 study compared with placebo (12-month survival, 26% vs 11%), and in Western patients in the single-arm CheckMate 032 study (12-month survival, 44%). This analysis aimed to establish comparator cohorts of US patients receiving routine care in real-world (RW) clinical practice. Methods A 2-step matching process generated RW cohorts from Flatiron Health’s oncology database (January 1, 2011–April 30, 2017), for comparison with each trial: (1) clinical trial eligibility criteria were applied; (2) patients were frequency-matched with trial arms for baseline variables significantly associated with survival. Median overall survival (OS) was calculated by Kaplan–Meier analysis from last treatment until death. Results Of 742 adv/met GC/GEJC patients with at least 2 prior lines of therapy, matching generated 90 US RW ATTRACTION-2-matched patients (median OS: 3.5 months) versus 163 ATTRACTION-2 placebo patients (median OS: 4.1 months), and 100 US RW CheckMate 032-matched patients (median OS: 2.9 months) versus 42 CheckMate 032 nivolumab-treated patients (median OS: 8.5 months). Baseline characteristics were generally similar between clinical trial arms and RW-matched cohorts. Conclusions We successfully developed RW cohorts for comparison with data from clinical trials, with comparable baseline characteristics. Survival in US patients receiving RW care was similar to that seen in Asian patients receiving placebo in ATTRACTION-2; survival with nivolumab in CheckMate 032 appeared favorable compared with US RW clinical practice.
- Published
- 2019