Abstract Prior studies show racial disparities in tx access and mortality in GC/GEJC/EAC, yet the effect of race on 1L tx outcomes is unclear. We evaluated tx patterns and outcomes by race in pts who received 1L tx for GC/GEJC/EAC in the US. This retrospective, observational study used the Flatiron Health Research Database. Adults starting 1L tx between May 1, 2021, and Nov 30, 2024 for HER2-negative/unknown GC/GEJC/EAC were included. End of follow-up was May 31, 2025 to allow for ≥6 months of follow-up. Flatiron categorized self-reported race as White, Black/African American (Black), Asian, or other (multiple categories/not listed). RW overall survival (OS), time to next tx/death (TTNTD), and time to tx discontinuation (TTD) were estimated via the Kaplan-Meier method and compared between race categories. Of 2128 eligible pts, 61% were White, 8% Black, 3% Asian, 8% other, and 20% unknown race. Most were treated in community-based oncology practices (77%-79%). Median age was similar across racial groups (69 years); 25% (White), 76% (Black), and 77% (Asian) of pts had GC. Median OS (12.0 vs 13.0 months) and TTNTD (7.6 vs 6.7 months) were similar in Black vs White pts; median TTD was numerically longer in Black vs White pts (4.3 vs 2.3 months). However, the differences in clinical outcomes between Black and White pts were not statistically significant (hazard ratio 95% confidence interval: OS, 0.97 0.78-1.20; TTNTD, 0.93 0.77-1.13; TTD, 0.92 0.76-1.10) after adjusting for key baseline confounders (Table). These findings underscore the potential impact of equitable 1L tx access in minimizing racial disparities in pts with HER2-negative/unknown a/m GC/GEJC/EAC. Larger studies are needed to assess the influence of disease prognosis and other variables, but this study highlights the value of RW data in advancing health equity and guiding future clinical interventions. Citation Format: Jin Gu, Ravindra Gupta, Daniel O. Koralek, Aliki Taylor, Jaffer A. Ajani. Real-world (RW) outcomes by race in patients (pts) receiving first-line (1L) treatment (tx) for advanced/metastatic (a/m) gastric, gastroesophageal junction, or esophageal adenocarcinoma (GC/GEJC/EAC) abstract. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 5413.
Gu et al. (Fri,) studied this question.
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