National Utilization of Imatinib in the Management of Resected Gastrointestinal Stromal Tumors

Rachel K. Voss, Nader N. Massarweh, Yi Ju Chiang, Neeta Somaiah, Barry W. Feig, Christina L. Roland

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Imatinib decreases recurrence risk and improves overall survival (OS) in localized gastrointestinal stromal tumors (GISTs); however, the extent to which patients receive appropriate treatment in the US has not been well characterized. Methods: Patients with non-metastatic, resectable GIST were included in this study (National Cancer Database, 2010–2015). Those with a low-risk of recurrence were classified as receiving overtreatment or guideline-concordant treatment, while those with a high-risk of recurrence were classified as receiving undertreatment or guideline-concordant treatment. Multivariable logistic regression was used to determine factors associated with non-concordant treatment. The association between non-concordant treatment and OS was evaluated using multivariable Cox regression and propensity score matching. Results: Among 3088 patients with high-risk GIST, 41% were undertreated, and among 3908 patients with low-risk GIST, 18.8% were overtreated. For patients with high-risk GIST, age > 60 years, African American race, and treatment at a community or comprehensive cancer program were associated with undertreatment. Among low-risk patients, small bowel primary, tumor size > 2 cm, and tumors with > 1 mitotic figure per 50 high-power fields were more likely to be overtreated. After propensity score matching, guideline-concordant therapy was associated with an 8.8% improvement in 5-year OS (81.9% vs. 73.1%, p = 0.002) for those with high-risk GIST and decreased risk of death (hazard ratio 0.63, 95% confidence interval 0.47–0.84). There was no statistically significant difference in survival for patients with low-risk GIST with the addition of imatinib overtreatment (overtreatment 93.9% vs. 89.6%, p = 0.053). Conclusions: Nearly 30% of GIST patients do not receive guideline-concordant treatment and future work is needed to understand the factors driving non-concordant treatment.

Original languageEnglish (US)
Pages (from-to)9159-9168
Number of pages10
JournalAnnals of surgical oncology
Volume28
Issue number13
DOIs
StatePublished - Dec 2021

ASJC Scopus subject areas

  • Surgery
  • Oncology

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