ArticleThe oncologist2026
Real-world treatment landscape and clinical outcomes in first-line advanced or metastatic gastroesophageal adenocarcinoma in the United States.
Article in The oncologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Abstract
backgroundContemporary real-world evidence in advanced gastric, gastroesophageal junction, or esophageal adenocarcinoma (GC/GEJC/EAC) remains limited. This study evaluated real-world treatment patterns and clinical outcomes in patients with advanced GC/GEJC/EAC treated with first-line therapy in the United States. PATIENTS AND
methodsTreatment patterns were assessed in adults from the Flatiron database with advanced or metastatic HER2-negative GC/GEJC/EAC who initiated first-line treatment between May 1, 2021, and July 31, 2025 (overall cohort). Clinical outcomes were assessed using the Kaplan-Meier method in a subcohort with ≥6 months of follow‑up.
resultsAmong 2340 eligible patients, the most common first-line regimen was IO+FOLFOX/CAPOX (31.6%). This regimen was used in 47.6% of patients with programmed cell death ligand 1 (PD-L1) combined positive score (CPS) ≥ 1 expression. Starting in 2024, zolbetuximab+FOLFOX/CAPOX was administered more frequently in patients with CPS <1 vs ≥1 (6.1% vs 1.9%) and CPS <5 vs ≥5 (4.6% vs 0.8%) expression. In the subcohort (n = 2117), IO+FOLFOX/CAPOX vs FOLFOX/CAPOX was associated with significantly longer median (months; hazard ratio [95% CI]) real-world overall survival (12.3 vs 11.3; 0.81 [0.69-0.94]), time to next treatment or death (8.0 vs 6.1; 0.64 [0.55-0.75]), and time to treatment discontinuation (6.0 vs 3.0; 0.54 [0.47-0.63]). Differences in outcomes were driven by patients with CPS ≥1 expression, with no differences in patients with CPS <1 expression.
conclusionsIO+FOLFOX/CAPOX was the most frequent first-line regimen in advanced or metastatic GC/GEJC/EAC and showed improved real-world outcomes vs FOLFOX/CAPOX. Despite these gains, overall survival remains poor, underscoring unmet needs and the importance of biomarker-informed treatment selection.
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