Introduction

Gastric cancer remains one of the leading causes of death internationally and a major health concern in the United States (US). To develop better prevention strategies, this study quantifies trends in gastric cancer related mortality, stratified by age, sex, region, urbanity, and race over two decades.

Aims & Methods

Our study used the CDC WONDER database to analyze death certificates from 1999 to 2022 across the U.S. ICD codes C16.0-C16.9 were used to identify the relevant cases. Demographic variables such as sex, race, age, urban-rural classification, and census regions were analyzed. Trends in AAMR were assessed using the Joint Point Regression Program to determine annual percentage changes (APC).

Results

Overall mortality related to malignant stomach neoplasms in the US declined significantly (Table 1) from 79.26 (1999) to 44.81 (2022), with notable periods of steep decrease between 1999–2006 (APC -3.51, 95% CI: -5.16 to -2.78) and 2006–2018 (APC -2.27, 95% CI: -3.55 to -1.83). Men consistently exhibited higher mortality rates than women (overall men: 81.14 vs women: 42.10). Men experienced an initial significant drop from 113.45 to 78.68 (1999–2009, APC -3.55), followed by a slower decrease till 2022 (APC -2.22). Women's mortality showed an initial sharp decline (1999–2008, APC -3.11), then a modest reduction from 2008–2018 (APC -1.96), plateauing thereafter.

Racially, Non-Hispanic (NH) Black individuals exhibited the highest mortality (109.37), followed by NH Asians/Pacific Islanders (102.47), Hispanic/Latino (91.93), NH American Indian/Alaskan Natives (78.21), and NH White (44.85). NH Blacks demonstrated a marked initial decrease (159.46 to 119.13 by 2017) then plateaued. NH Whites showed a continuous decline (1999–2018), slowing post-2018. Hispanics had two significant declining periods (1999–2011, APC -2.82; 2011–2022, APC -1.56), whereas NH Asians and NH American Indians steadily declined throughout.

Mortality by age was highest among older adults (202.46), followed by middle-aged (60.58) and young adults (40.55). Older adults had two notable decreasing phases (1999–2009, APC -3.56; 2009–2018, APC -2.89), with slower decline afterward. Middle-aged adults showed an initial steep decline (1999–2005, APC -3.65), followed by gradual reduction (2005–2022, APC -0.79). Young adults exhibited minimal, non-significant declines throughout.

Regionally, the Northeast showed highest mortality (64.78), followed by West, South, and Midwest. Both metropolitan and non-metropolitan areas saw significant mortality reductions, with non-metropolitan areas consistently having higher rates overall.

Table 1. Annual Percent Change (APC) in mortality rates by selected demographics, 1999–2022.
APC values are presented with 95% confidence intervals (CI). Asterisk (*) indicates statistically significant APC values (p < 0.05).

Conclusion

Gastric carcinoma has poor prognosis, and although the general trend is decreasing across all socio-demographic areas, further research is required for targeted interventions and health policies for populations at high risk of dying.

References

1. Stahl KA, Olecki EJ, Dixon ME, et al. Gastric cancer treatments and survival trends in the United States. Current Oncology. 2020;28(1):138-151. doi:10.3390/curroncol28010017
2. Kumar RK, Raj SS, Shankar EM, Ganapathy E, Ebrahim AS, Farooq SM. Gastric carcinoma: a review on epidemiology, current surgical and chemotherapeutic options. Gastric Carcinoma-New Insights into Current Management. 2013/1/13 2013;12doi:10.5772/52138
3. Li C, Chen D, Yang H. Trends in incidence, survival and mortality of gastric cancer in the United States: a population-based study, 2001-2015. Asian Pacific Journal of Cancer Prevention: APJCP. 2023;24(6):2011-2020. doi:10.31557/APJCP.2023.24.6.2011
4. Hudler P, Komel R. Clinical Implications of Molecular Heterogeneity of Gastric Cancer. Gastric Cancer. 2017/9/20 2017;doi:10.5772/intechopen.69775
5. Ali H, Ishtiaq R, Tedder B, et al. Trends in mortality from gastrointestinal, hepatic, and pancreatic cancers in the United States: A comprehensive analysis (1999–2020). JGH Open. 2024;8(4):e13064. doi: 10.1002/jgh3.13064

Disclosure

No conflicts of interest to disclose.

Introduction

Vedolizumab (VDZ), a gut-selective anti-lymphocyte trafficking drug indicated for Crohn's disease (CD), is administered intravenously at Weeks 0, 2, and 6, then every 8 weeks (Q8W). Dose escalation to every 4 weeks (Q4W) may recapture response to treatment in ~50% of patients with inadequate/loss of response. Factors associated with VDZ dose escalation from Q8W to Q4W and real-world outcomes remain underexplored.

Aims & Methods

Adults with moderate to severe CD initiating VDZ Q8W maintenance therapy were prospectively followed in a Canadian patient support program (2015-2023). Two cohorts were included: 1) patients escalated to Q4W during maintenance therapy any time after week 14 infusion (Q8W>Q4W maintenance) and 2) patients maintained on Q8W treatment for ≥2 years without dose escalation (Q8W maintenance). Baseline characteristics were summarized as median (range) and frequency (%) and compared between cohorts. Rates of clinical remission (Harvey-Bradshaw Index [HBI]<5) were described stratifying by prior biologic experience. Associations between baseline factors and clinical remission 3 months after Q4W dose escalation were assessed using Wilcoxon rank sum test and Fisher’s exact test. Treatment persistence at 12 and 24 months after treatment initiation and dose escalation were evaluated in the Q8W>Q4W cohort using Kaplan-Meier survival analysis.

Results

250 patients were included in the Q8W>Q4W maintenance cohort (39% bio-naïve), and 116 in the Q8W maintenance cohort (51% bio-naïve). In both cohorts, median age at treatment initiation was 50 years and baseline HBI score was 10. In the Q8W>Q4W maintenance cohort, median disease duration prior to initiation of treatment was 14 years (0-69) and median follow-up duration was 22 months (7-60). In the Q8W cohort, median disease and follow-up duration were 8 years (0-50) and 35 months (27-46), respectively. At 14 weeks post-treatment initiation, rates of remission in the Q8W>Q4W maintenance cohort were 47% (bio-naïve) and 22% (bio-experienced), and in the Q8W cohort 61% (bio-naïve) and 48% (bio-experienced) (Table 1). Among patients in the Q8W>Q4W maintenance cohort not in remission at the time of dose escalating, 33% achieved remission 3 months after dose escalation to Q4W. Disease duration at baseline was shorter in these patients than in those who did not achieve remission (8 months [0-52] vs. 16 months [0-69], p=0.007). In the Q8W>Q4W maintenance cohort, 12- and 24-month treatment persistence after treatment initiation was 91% and 64% (bio-naïve) and 94% and 67% (bio-experienced), respectively. After dose escalation, 12- and 24-month treatment persistence was 66% and 59% (bio-naïve) and 69% and 53% (bio-experienced) (Table 1).

Conclusion

Patients with CD who underwent VDZ Q8W>Q4W dose escalation achieved lower rates of clinical remission than those remaining on Q8W treatment, and one third achieved clinical remission 3 months after dose escalating. Baseline disease duration was significantly associated with remission among those escalating to Q4W.

References

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Disclosure

AHS: Advisory Board Membership/Consultant: Abbvie, Amgen, BioJAMP, BMS, Celltrion, Fresenius Kabi, Janssen, McKesson, Mylan Pharmaceuticals, Organon, Pendopharm, Roche, Pfizer, Sandoz, Takeda, Viatris, Speakers’ Bureau: Abbvie, Amgen, Ferring, Fresenius Kabi, Janssen, Organon, Pfizer, Sandoz, Takeda, Research Grants: Abbvie, Arena, Celgene/BMS, Genentech, Janssen, Roche, Takeda.
EJB: Participation in advisory boards or speaker services: Abbvie, Janssen, Takeda, Pfizer, Merck, Amgen, Pendopharm, Jamp, Fresenius, Kabi, Bausch Health, Celltrion, Eli Lilly, BMS, Grant/Research: Janssen, Abbvie, Any other investment or relationship that could be judged by a reasonable and knowledgeable participant to have the potential to influence the content of the training activity, Abbvie, Janssen, Takeda, Pfizer, Merck, Amgen, Pendopharm, Jamp, Fresenius, Kabi, Bausch Health, Celltrion, BMS.
JFL: AbbVie, BMS, Janssen, Frenesius-Kabi, Pfizer, Sandoz, Takeda. AHS: Advisory Board Membership/Consultant: Abbvie, Amgen, BioJAMP, BMS, Celltrion, Fresenius Kabi, Janssen, McKesson, Mylan Pharmaceuticals, Organon, Pendopharm, Roche, Pfizer, Sandoz, Takeda, Viatris, Speakers’ Bureau: Abbvie, Amgen, Ferring, Fresenius Kabi, Janssen, Organon, Pfizer, Sandoz, Takeda, Research Grants: Abbvie, Arena, Celgene/BMS, Genentech, Janssen, Roche, Takeda.
PW: Personal fees from AbbVie, Ferring, Biogen, and Janssen
MJA, AW, RW: were employees of Takeda Canada Inc. at the time of the study.
RM, JW, CP: were employees of Pentavere Research Group Inc. at the time of the study.
LPB: Consulting from AbbVie, Alimentiv, Alma Bio Therapeutics, Amgen, Applied Molecular Transport, Arena, Biogen, BMS, Celltrion, CONNECT Biopharm, Cytoki Pharma, Enthera, Ferring, Fresenius Kabi, Galapagos, Genentech, Gilead, Gossamer Bio, GSK, HACPharma, IAG Image Analysis, Index Pharmaceuticals, Inotrem, Janssen, Lilly, Medac, Mopac, Morphic, MSD, Norgine, Novartis, OM Pharma, ONO Pharma, OSE Immunotherapeutics, Pandion Therapeutics, Par’Immune, Pfizer, Prometheus, Protagonist, Roche, Sanofi, Sandoz, Takeda, Theravance, Thermo Fisher, Tigenix, Tillots, Viatris, Vifor, Ysopia, Abivax, Samsung, Ventyx, Roivant, and Vectivbio; grants from Takeda, Fresenius Kabi, and Celltrion; and lecture fees from Galapagos, AbbVie, Janssen, Genentech, Ferring, Tillots, Celltrion, Takeda, Pfizer, Sandoz, Biogen, MSD, Amgen, Vifor, Arena, Lilly, Gilead, Viatris, and Medac.
BB: Advisor/Speaker: Ferring, Janssen, Abbvie, Takeda, Pfizer, BMS, Merck, Sandoz, Organon, Lifelabs, Celltrion. Advisor: Alimentiv, Gilead, Iterative Health, AMT, Celgene, Merck, Amgen, Pendopharm, Eli Lilly, BMS, Fresenius Kabi, Mylan, Viatris, Bausch Health, Celltrion Healthcare, BioJamp Pharma, Eupraxia. Research support: Janssen, Abbvie, GSK, BMS, Amgen, Genentech, Merck. Stock Options: Qu Biologic.