Improved Efficacy of First-Line Imatinib in Advanced Gastrointestinal Stromal Tumors (GIST): The Dutch GIST Registry Data

Abstract

Background Patients with unresectable and metastasized gastrointestinal stromal tumor (GIST) experienced a remarkable improvement of progression-free survival (PFS) and overall survival (OS) after the introduction of imatinib. Our hypothesis is that the outcomes of treatment with imatinib are even better nowadays compared with the registration trials that were performed two decades ago. To study this, we used real-life data from a contemporary registry. Methods A multicenter, retrospective study was performed by exploring clinical data from a prospective real-life clinical database, the Dutch GIST Registry (DGR). Patients with advanced GIST treated with first-line imatinib were included and PFS (primary outcome) and OS (secondary outcome) were analyzed. Results of our study were compared with published results of the European Organisation for Research and Treatment of Cancer (EORTC) 62005 trial, which marked the first era of imatinib in the treatment of GIST. Results Overall, 420 of the 435 patients treated with imatinib in the DGR had recorded response evaluation and were included in the analysis. During a median follow-up of 35.0 months (range 2.0–136.0), progression of GIST was eventually observed in 217 patients (51.2%). The DGR cohort showed a longer median PFS (33.0 months, 95% confidence interval [CI] 28.4–37.6) compared with the EORTC 62005 trial (an estimated PFS of 19.5 months). Additionally, the median OS of 68.0 months (95% CI 56.1–80.0) was longer than the exposed median OS (46.8 months) published in the long-term follow-up results of the EORTC 62005 trial (median follow-up duration 10.9 years). Conclusion This study provides an update on outcomes of imatinib in the treatment of advanced GIST patients and demonstrates improved clinical outcomes since the first randomized studies of imatinib 2 decades ago. Furthermore, these results represent outcomes in real-world clinical practice and can serve as a reference when evaluating effectiveness of imatinib in patients with advanced GIST.

Prognostic factors for liver metastasis in patients with small intestinal stromal tumor: A retrospective analysis of surveillance, epidemiology, and end results

“…Imatinib's targeted action, resulting in tumor reduction and prevention of metastasis, along with its ability to prolong progression-free survival and serve as adjuvant therapy, has been supported by a significant amount of research, demonstrating its safety, effectiveness, and positive impact on the prognosis of patients with GIST. [18][19][20] Chemotherapy plays a vital role in eradicating residual tumor cells, controlling tumor growth, and reducing the risk of metastasis. The absence of chemotherapy may result in the failure to suppress the metastatic potential of tumor cells, thereby facilitating the occurrence of LIM.…”

Fear, anxiety and depression in gastrointestinal stromal tumor (GIST) patients in the Netherlands: Data from a cross-sectional multicenter study

“…In one in five patients the GIST has already metastasized to the peritoneum or liver at diagnosis ( van der Graaf et al., 2018 ), these patients often depend on life-long treatment with tyrosine kinase inhibitors (TKIs), of which imatinib is the first line. Imatinib significantly improved the median survival of metastatic GIST patients from 12 to 68 months ( Mohammadi et al., 2023 ). After failure of imatinib, sunitinib, regorafenib and ripretinib are currently registered ( Casali et al., 2022 ).…”

Financial difficulties experienced by patients with gastrointestinal stromal tumours (GIST) in the Netherlands: data from a cross-sectional multicentre study

“…Furthermore, one in five patients present with metastatic disease at diagnosis [ 1 ], while others may develop metastases during follow-up. Metastatic GIST patients depend on life-prolonging treatment with TKIs, such as imatinib, which significantly improved their median overall survival from 12 to 68 months [ 15 ].…”