P-127 The screening and consensus based on practices and evidence (SCOPE) survey – results of a real-world survey on practice patterns in gastric cancer

The SCOPE gastrointestinal (GI) program gathered real-world insights on the management of patients with metastatic gastric cancer (mGC), colorectal cancer, and pancreatic cancer. Results on prescribing patterns and treatment decisions in different settings for patients with mGC are reported. An international panel of expert GI oncologists developed the SCOPE GI cancer survey. Healthcare professionals (HCPs) were asked about their management of patients with GC, and their third-line (3L) and fourth-line (4L) treatment decisions for several real-world patient cases. Data were collected at in-person and virtual meetings conducted from July 2021–December 2022. In total, 499 HCPs participated across 17 countries in Europe, the Middle East, and Latin America. The majority (82%) were medical oncologists and practiced in public hospitals/clinics (76%). In total, 93%, 62%, and 52% of HCPs tested for HER2, MMR/MSI, and PD-L1 status at diagnosis, respectively. The main 3L treatment goals were preserving quality of life (QOL; 31%), prolonging overall survival (26%), and relieving symptoms (16%). HCPs reported that 25% of patients refused active treatment in the 3L; the main reasons were deterioration/limitation of daily activities (37%) and concerns regarding efficacy of the current 3L treatment options (36%). When a patient refuses active treatment, 57% of HCPs would explore the reasons and recommend appropriate treatment, if possible, while 38% would accept the patient’s decision and opt for best supportive care (BSC). Considering a 63-year-old unfit (ECOG PS 2) patient, pMMR/MSS, HER2 negative, and PD-L1 combined positive score (CPS) 0, who received 1L FOLFOX/5-FU and 2L FOLFIRI, 93% of HCPs stated trifluridine-tipiracil was an appropriate 3L treatment; the main drivers were survival data for 54% of HCPs and QOL for 21% of HCPs. Trifluridine-tipiracil was selected as the 3L treatment of choice (74%) for this patient regardless of whichever 1L or 2L treatments had been administered; the 2 most favored 4L choices were BSC (44%) and trifluridine-tipiracil (21%). If the patient was older (78-year-old), trifluridine-tipiracil remained the preferred 3L treatment (73%), although the proportion of HCPs who would prescribe BSC in 4L increased to 87%. For a fit (ECOG 1) 64-year-old with HER2 and pMMR/MSS negative, PD-L1 CPS 0 disease, who received 1L FOLFOX/5-FU and 2L ramucirumab/paclitaxel, 89% of HCPs stated that trifluridine-tipiracil was an appropriate 3L treatment, driven by the phase III survival data (44%) and QOL (18%). Regardless of the 1L or 2L treatment, trifluridine-tipiracil remained the 3L treatment of choice for this patient. BSC was the preferred 4L treatment (32%) overall, although there was some regional variation with HCPs in Western Europe preferring trifluridine-tipiracil while those in Central/Eastern Europe opted most frequently for irinotecan monotherapy. In mGC, HER2 and MMR/MSI were tested most frequently at diagnosis. PD-L1 testing may increase now, due to availability of immune checkpoint inhibitors in 1L. The main 3L treatment goals were to preserve QOL, prolong survival, and relieve symptoms, which aligned with patients’ concerns about deterioration of daily activities. The preferred 3L treatment choice was trifluridine-tipiracil, and BSC was the preferred 4L option.