Table 4.
Reasons for discordance (n = 38).
| n = 38 | Stage IV or recurrent vs. others | |
|---|---|---|
| (I) WFO does not consider patients' complex medical history | ||
|
| ||
| Case 1. Recurrent gastric cancer with lymph node metastasis and a prior good response to FOLFOX (i) WFO recommended ramucirumab + Paclitaxel, (ii) GMDT recommended FOLFOX |
1 | 1:0 |
|
| ||
| Case 2. Recurrent gastric cancer with solitary bone metastasis (i) WFO recommended ramucirumab + paclitaxel, (ii) GMDT recommended palliative radiation therapy |
1 | 1:0 |
|
| ||
| (II) Adjuvant therapy in patients who underwent curative resection of gastric cancer who were younger and in good condition (i) WFO recommended postoperative adjuvant fluoropyrimidine- based chemoradiation to patients with stage II or III disease, (ii) GMDT recommended S-1 monotherapy |
4 | 0:4 |
|
| ||
| (III) Adjuvant therapy in patients who underwent curative resection of gastric cancer who were older or had a complex medical history (i) WFO recommended postoperative adjuvant fluoropyrimidine-based chemoradiation to patients with stage II or III disease, (ii) GMDT recommended S-1 monotherapy |
9 | 0:9 |
|
| ||
| (IV) Adjuvant therapy in patients with locally advanced gastric cancer who underwent curative resection of gastric cancer (i) WFO recommended Capecitabine+Oxaliplatin (ii) GMDT recommended S-1 monotherapy |
6 | 0:6 |
|
| ||
| (V) Metastatic gastric cancer with HER2/neu (i) WFO recommended dose modified DCF or FOLFOX (ii) GMDT recommended capecitabine+cisplatin or 5-FU+cisplatin |
11 | 11:0 |
|
| ||
| (VI) Patients wanted to be involved in a clinical trial | 3 | 3:0 |
|
| ||
| (VII) Financial problem, WFO recommended a biologic agent, but patient refused for financial reasons (not covered by the KNHIS) | 3 | 3:0 |
FOLFOX, Oxaliplatin, Folinic Acid, and 5-Fluorouracil; 5-FU, 5 Fluorouracil; KNHIS, Korean National Health Insurance System; HER2/neu, human epidermal growth factor receptor; DCF, docetaxel, cisplatin, and 5FU.