Reviewer ’s report  
 
Title: Real-world treatment patterns, healthcare resource use an d clinical outcomes of patients 
receiving second line therapy for advanced or metastatic gastric cancer.  
 
Version: 0 Date: 19 Feb 2020  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other arti cle types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
Yes - the approach is appropriate  
 
 
EXECUTION - Are the experiments and ana lyses performed with technical rigor to allow 
confidence in the results?  
 
No - there are minor issues  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
No - there are issues with the statistics in the study  
 
 
INTERPRETATION - Is the curre nt interpretation/discussion of the results reasonable and not 
overstated?  
 
Yes - the author's interpretation is reasonable  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
 
Probably - with minor revisions  
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: The manuscript concerns sec ond-line treatment choices for gastric 
cancer.  
 
No novel methodology was used.  
 
The manuscript only adds background data and observational results for gastric cancer. Though 
this manuscript is well -written, the information in it is not so important and is al ready well -
known in the literature.  
 
This manuscript mainly reports a multi -national retrospective case series study. This study is not 
interventional -- only an observational cohort study. The authors searched for second -line 
treatment choices across countr ies and report their results. The authors have used proper 
statistics.  
 
They report that over 50 percent of patients were treated with a single agent, mostly taxanes, and 
30 percent of the patients were treated with the FOLFIRI regimen. They found for all p atients, 
PFS and OS were 3.09 and 6.54 months, respectively. These are all compatible with the 
literature. In variate analysis, they found that the doublet regimen did not change the effect 
significantly on the PFS and OS.  
 
On the other hand, in daily pract ice, most of the time second -line treatment choices were affected 
by the first -line treatment. For example, if the patient takes triplet regime at the first line, he/she 
was probably treated with the doublet regimen. Therefore, it was very important to rep ort the 
patients first -line treatments and also the elapsed period from the first -line treatment to the 
second -line treatment. I strongly believe that these parameters all have to be included in 
univariate and multivariate analysis.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following question s: 
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or sha res in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you re ceived reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interes ts in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research  Squa re. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journ al. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for m y report to be made available under an Open Access Creative Co mmons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Real-world treatment patterns, healthcare resource use an d clinical outcomes of patients 
receiving second line therapy for advanced or metastatic gastric cancer.  
 
Version: 0 Date: 19 Feb 2020  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other arti cle types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
Yes - the approach is appropriate  
 
 
EXECUTION - Are the experiments and ana lyses performed with technical rigor to allow 
confidence in the results?  
 
No - there are minor issues  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
No - there are issues with the statistics in the study  
 
 
INTERPRETATION - Is the curre nt interpretation/discussion of the results reasonable and not 
overstated?  
 
Yes - the author's interpretation is reasonable  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
 
Probably - with minor revisions  
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: The manuscript concerns sec ond-line treatment choices for gastric 
cancer.  
 
No novel methodology was used.  
 
The manuscript only adds background data and observational results for gastric cancer. Though 
this manuscript is well -written, the information in it is not so important and is al ready well -
known in the literature.  
 
This manuscript mainly reports a multi -national retrospective case series study. This study is not 
interventional -- only an observational cohort study. The authors searched for second -line 
treatment choices across countr ies and report their results. The authors have used proper 
statistics.  
 
They report that over 50 percent of patients were treated with a single agent, mostly taxanes, and 
30 percent of the patients were treated with the FOLFIRI regimen. They found for all p atients, 
PFS and OS were 3.09 and 6.54 months, respectively. These are all compatible with the 
literature. In variate analysis, they found that the doublet regimen did not change the effect 
significantly on the PFS and OS.  
 
On the other hand, in daily pract ice, most of the time second -line treatment choices were affected 
by the first -line treatment. For example, if the patient takes triplet regime at the first line, he/she 
was probably treated with the doublet regimen. Therefore, it was very important to rep ort the 
patients first -line treatments and also the elapsed period from the first -line treatment to the 
second -line treatment. I strongly believe that these parameters all have to be included in 
univariate and multivariate analysis.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following question s: 
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or sha res in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you re ceived reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interes ts in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research  Squa re. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journ al. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for m y report to be made available under an Open Access Creative Co mmons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Real-world treatment patterns, healthcare resource use an d clinical outcomes of patients 
receiving second line therapy for advanced or metastatic gastric cancer.  
 
Version: 0 Date: 19 Feb 2020  
 
Reviewer: Reviewer 2  
 
Reviewer's report:  
 
PEER REVIEWER ASSESSMENTS:  
 
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research 
question(s) (brief or other arti cle types: is there a clear objective)?  
 
Yes - there is a clear objective  
 
 
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for the 
objective?  
 
Yes - the approach is appropriate  
 
 
EXECUTION - Are the experiments and ana lyses performed with technical rigor to allow 
confidence in the results?  
 
No - there are minor issues  
 
 
STATISTICS - Is the use of statistics in the manuscript appropriate?  
 
No - there are issues with the statistics in the study  
 
 
INTERPRETATION - Is the curre nt interpretation/discussion of the results reasonable and not 
overstated?  
 
Yes - the author's interpretation is reasonable  
 
 
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically 
sound? If not, can revisions be made to make the work technically sound?  
 
Probably - with minor revisions  
PEER REVIEWER COMMENTS:  
 
GENERAL COMMENTS: The manuscript concerns sec ond-line treatment choices for gastric 
cancer.  
 
No novel methodology was used.  
 
The manuscript only adds background data and observational results for gastric cancer. Though 
this manuscript is well -written, the information in it is not so important and is al ready well -
known in the literature.  
 
This manuscript mainly reports a multi -national retrospective case series study. This study is not 
interventional -- only an observational cohort study. The authors searched for second -line 
treatment choices across countr ies and report their results. The authors have used proper 
statistics.  
 
They report that over 50 percent of patients were treated with a single agent, mostly taxanes, and 
30 percent of the patients were treated with the FOLFIRI regimen. They found for all p atients, 
PFS and OS were 3.09 and 6.54 months, respectively. These are all compatible with the 
literature. In variate analysis, they found that the doublet regimen did not change the effect 
significantly on the PFS and OS.  
 
On the other hand, in daily pract ice, most of the time second -line treatment choices were affected 
by the first -line treatment. For example, if the patient takes triplet regime at the first line, he/she 
was probably treated with the doublet regimen. Therefore, it was very important to rep ort the 
patients first -line treatments and also the elapsed period from the first -line treatment to the 
second -line treatment. I strongly believe that these parameters all have to be included in 
univariate and multivariate analysis.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following question s: 
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or sha res in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you re ceived reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interes ts in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
This reviewer has been recruited by a partner organization, Research  Squa re. Reviewers with 
declared or apparent competing interests are not utilized for t hese reviews. This reviewer has 
agreed to publication of their comments online under a Creat ive Commons Attribution License 
attributed to Research Square and was paid a small honorarium for  completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journ al. I understand that my name will be included  
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for m y report to be made available under an Open Access Creative Co mmons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be in cluded as confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant