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Peyman Haghighat and Tanios Bekaii-Saab

mitomycin in patients with unresectable, advanced gastric cancer . J Clin Oncol 2003 ; 21 : 54 – 59 . 11. Findlay M Cunningham D Norman A . A phase II study in advanced gastro-esophageal cancer using epirubicin and cisplatin in combination

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Lisa Hazard, Gary Yang, Mary Frances McAleer, James Hayman, and Christopher Willett

. 1999 . 3. Gao XS Qiao X Wu F . Pathological analysis of clinical target volume margin for radiotherapy in patients with esophageal and gastroesophageal junction carcinoma . Int J Radiat Oncol Biol Phys 2007 ; 67 : 389 – 396 . 4

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Jaffer A. Ajani

gastroesophageal junction . N Engl J Med 2001 ; 345 : 725 – 730 . 5. Cooper JS Guo MD Herskovic A . Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01) . Radiation Therapy

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Brian Badgwell

anatomic location of the tumor and the proximity to the gastroesophageal Table 1. Overall Survival Rates for Trials of Resectable Gastric Cancer From Western and Eastern Centers junction (GEJ). Although lesions amenable to endoscopic mucosal

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Ronan J. Kelly

esophageal adenocarcinoma (EAC), but currently surgical intervention remains the best chance for cure in EAC. The Siewert classification of the gastroesophageal junction (GEJ) is used to determine whether an esophageal or a gastric treatment paradigm should

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Thomas B. Nealis, Kay Washington, and Rajesh N. Keswani

fastest rising malignancy among white men in the United States. 2 , 4 , 5 Risk factors include both genetic and environmental factors, including central obesity, smoking, and diet. 2 , 6 The 5-year survival rate for esophageal and gastroesophageal

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Robert E. Glasgow, David H. Ilson, James A. Hayman, Hans Gerdes, Mary F. Mulcahy, and Jaffer A. Ajani

epithelial dysplasia, and are associated with dietary and nutritional factors and, more importantly, tobacco and alcohol abuse. Adenocarcinomas arise in the lower third of the esophagus, are associated with gastroesophageal reflux disease and high body mass

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Jessica A. Davis, Zhanglin Lin Cui, Madiha Ghias, Xiaohong Li, Robert Goodloe, Astra M. Liepa, Kenyon Ogburn, and Lisa M. Hess

Background: Previous work has demonstrated treatment (tx) heterogeneity in the care of patients with aGC/GEJ. This study was designed to examine heterogeneity temporal trends and OS in patients with aGC/aGEJ in the United States from 2011 to 2018. Methods: The Flatiron Advanced/metastatic gastric/esophageal cohort electronic medical records (EMR) data were used for this study. Eligible patients were adults receiving anticancer therapy for aGC/GEJ during the study period. Tx patterns were summarized by line of therapy. Drugs were grouped by class. Heterogeneity was measured using the Herfindahl-Hirschman index (HHI); HHI scores range from 0.0000 (complete heterogeneity) to 1.0000 (complete homogeneity). A difference of 0.1000 in HHI scores is considered to be practically meaningful. HHI scores were calculated for each clinic with ≥10 patients. OS was estimated using Kaplan-Meier method. Trend analyses were conducted for HHI scores over time using a linear regression model. Results: There were 2,912 patients who met eligibility criteria. The median age of the study cohort was 67 years; majority were male (70.9%) and white (61.1%). aGC patients comprised the majority (n=1,630, 55.9%). Median OS from the start of first-line (1L) therapy was 12.7 months (95% CI: 12.07, 13.6). The most common 1L regimens were fluoropyrimidine + oxaliplatin (n=651, 22.4%), platinum (ie, cisplatin or carboplatin) + taxane (n=511, 17.5%), and single-agent fluoropyrimidine (n=280, 9.6%). 1,230 patients received second line (2L) and the most common regimens were ramucirumab + taxane (n=203, 16.5%), fluoropyrimidine + oxaliplatin (n=155, 12.6%), and platinum + taxane (n=101, 8.2%). Overall median HHI for 1L was 0.1728 (min/max: 0.0926–0.4380). Median 1L HHI for 2011–2012 was 0.21665 (min/max: 0.1626–0.3156) and was 0.2419 (min/max 0.1716–0.4583) for 2017–2018. There were no significant differences in HHI score over time (P=.078). Overall median HHI for 2L was 0.1309 (min/max: 0.0694–0.2400). Due to small number of sites with ≥10 patients, data in 2L were too limited to conduct time trend analyses. Conclusions: Heterogeneity in 1L treatment of gastric/GEJ cancer persists, despite the continued refinement of guidelines and approval of new drugs in subsequent lines of therapy. Further analyses are needed to examine the relationship between heterogeneity, guideline adherence, and patient outcomes. These future data will shed light on the persistence of heterogeneous treatment patterns observed in the United States.

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Kavea Panneerselvam, Rajan N. Amin, Dongguang Wei, Dongfeng Tan, Phillip J. Lum, Hao Chi Zhang, David M. Richards, Mehmet Altan, Petros Grivas, John A. Thompson, Anusha S. Thomas, and Yinghong Wang

of Texas MD Anderson Cancer Center (MDACC) receiving ICI-based therapy from June 2011 to January 2020 who underwent upper endoscopies revealing esophagitis. Patients with preexisting gastroesophageal reflux disease (GERD), eosinophilic esophagitis

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Raymond Jang, Gail Darling, and Rebecca K.S. Wong

gastroesophageal junction (GEJ) is arguably one of the most challenging. In 2010, the 7th edition of the Union for International Cancer Control (UICC) TNM staging system provided clarification for the classification of junctional tumors. Specifically, tumors with