Optimal timing for initiating first-line palliative systemic therapy in asymptomatic metastatic esophagogastric cancer: Insights from a European Delphi study

European Journal of Cancer, vol. 218, pp. 115278

Abstract

BACKGROUND: The enhanced application of imaging techniques is resulting in the diagnosis of more patients with asymptomatic metastatic esophagogastric cancer (mEGC). We conducted a Delphi study to gather insights from European experts on the optimal timing for initiating palliative systemic therapy for these patients. METHODS: An online survey featured 14 scenarios where physicians chose their preferred timing for initiating systemic therapy: immediate(<3 weeks) or deferred. The standard scenario was a 65-year-old male, WHO/ECOG 0 with asymptomatic mEGC, 2 metastases in each lung, HER2 -, PDL1-CPS 2. In every subsequent case, one characteristic was modified. To investigate the fortitude of the physicians' preference for an immediate start, scenarios also included a patient who was motivated to start but preferred to defer if the physician deemed it judicious. Consensus was defined as ≥ 75 % agreement; scenarios without consensus were re-evaluated in Delphi round 2. RESULTS: Thirty-nine physicians participated in the first round, and 33 in the second round. Consensus to start treatment immediately was reached in 12 (86 %) scenarios. When patients preferred to defer, the consensus was to still advise to start palliative systemic treatment immediately in half (n = 7) of the scenarios. Only 2 scenarios (pre-existent WHO/ECOG 2 or 78 years old) reached the consensus that treatment could be deferred. CONCLUSIONS: In asymptomatic mEGC, immediate start of treatment is preferred by European experts. Consensus was established that treatment can be deferred for patients who prefer deferral and either have a pre-existent WHO/ECOG performance status of 2 or are of advanced age.

Authors 19

1. Denice Kamp

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

2. Anne Maria May

   Utrecht University · University Medical Center Utrecht

   Affiliation as printed

   Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands

3. Antoine Adenis
   Affiliation as printed

   Medical Oncology department, Institut du Cancer de Montpellier, Montpellier, France

4. Andreia Capela

   Unidade Local de Saúde Gaia/Espinho

   Affiliation as printed

   Department of Medical Oncology, Unidade Local de Saúde de Gaia e Espinho, Villa Nova de Gaia, Portugal

5. Sarah Derks

   Amsterdam University Medical Centers · Cancer Center Amsterdam

   Affiliation as printed

   Department of Medical Oncology, Amsterdam UMC, Free University, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands

   Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands

   Department of Medical Oncology, Amsterdam UMC, Free University, Amsterdam, the Netherlands

6. Francesca De Felice

   Policlinico Umberto I · Sapienza University of Rome

   Affiliation as printed

   Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Policlinico Umberto I, Rome, Italy

7. Nina Fokter Dovnik

   University Clinical Centre Maribor

   Affiliation as printed

   Department of Oncology, University Medical Centre Maribor, Maribor, Slovenia

8. Cinta Hierro

   Institut Català d'Oncologia

   Affiliation as printed

   Medical Oncology Department, Catalan Institute of Oncology (ICO)-Badalona, Badalona-Applied Research Group in Oncology (B-ARGO), Barcelona, Spain

9. Aysegül Ilhan‐Mutlu

   Medical University of Vienna

   Affiliation as printed

   Division of Oncology, Department of Medicine I, Medical University of Vienna, Vienna, Austria

10. Florian Lordick

    Leipzig University

    Affiliation as printed

    University Cancer Center Leipzig, University of Leipzig, Leipzig, Germany

11. Radka Lordick Obermannova

    Masaryk University · Masaryk Memorial Cancer Institute

    Affiliation as printed

    Department of Comprehensive Cancer Care and Faculty of Medicine, Masaryk University, Masaryk Memorial Cancer Institute, Brno, Czech Republic

12. Angelica Petrillo

    Regione Campania

    Affiliation as printed

    Medical Oncology unit, Ospedale del Mare, Via E. Russo, Naples, Italy

13. Alberto Puccini

    Humanitas University · IRCCS Humanitas Research Hospital

    Affiliation as printed

    Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan 20072, Italy; Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy

    Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy

    Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Humanitas Cancer Center, Rozzano, Milan, Italy

14. Giandomenico Roviello

    University of Florence

    Affiliation as printed

    Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Florence, Florence, Italy

15. Alexander Reinhard Siebenhüner

    Klinik Hirslanden

    Affiliation as printed

    Clinic for Hematology and Oncology, Hirslanden Zurich AG, Zurich, Switzerland

16. Marije Slingerland Aachen Department of Medical Oncology

    Leiden University Medical Center

    Affiliation as printed

    Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands

17. Elizabeth C. Smyth

    Oxford University Hospitals NHS Trust

    Affiliation as printed

    Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom

    Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford, The United Kingdom

18. Hanneke W.M. van Laarhoven

    Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam

    Affiliation as printed

    Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands

    Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands

    Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands

19. Nadia Haj Mohammad corresponding

    Utrecht University · University Medical Center Utrecht

    Affiliation as printed

    Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. Electronic address: n.hajmohammad@umcutrecht.nl

    Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands