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Treatment Patterns, Prescribing Decision Drivers, and Predictors of Complete Response Following Disease Recurrence in Gastrointestinal Stromal Tumor Patients—a Chart Extract-Based Approach

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Abstract

Purpose

The aim of this study was to investigate tumor characteristics, treatment patterns, and outcomes in recurrent KIT + GIST patients treated in a community practice setting.

Methods

An online tool was used to retrieve data on 410 patients treated with adjuvant imatinib mesylate (IM) for primary resectable KIT + GIST, who discontinued, had a recurrence, and then restarted IM or initiated sunitinib. Tumor characteristics at recurrence, treatment patterns, and factors associated with post-recurrence complete response (CR) achievement were analyzed.

Results

About 72.7 % of patients did not have surgery post-recurrence as majority of them had unresectable (45 %), metastatic (40 %), or multifocal tumors (62.4 %). Following recurrence, 76.6 % of patients were re-started on IM and 23.4 % on sunitinib; patients were 7.37 times more likely to re-start IM if initial treatment duration was ≤18 months (p < 0.001). Patients were also more likely to re-start IM if recurrence occurred >12 months post-discontinuation, or they had a recurrence inside the GI system, lower or unknown Fletcher risk score at primary diagnosis, or lower mitotic rate, (odds ratio (OR) = 3.54, p < 0.001; OR = 2.64, p = 0.006; OR = 2.55, p = 0.007; and OR = 2.45, p = 0.002, respectively). About 22.4 % achieved CR; patients were more likely to achieve CR if they had unifocal tumor at recurrence, inside the GI system, of ≤2 cm, or had lower mitotic rate (OR = 2.61, p < 0.001; OR = 2.27, p = 0.036; OR = 2.16, p = 0.023, OR = 1.87, p = 0.017, respectively).

Conclusions

IM treatment duration at primary diagnosis, time to develop recurrence after IM discontinuation, tumor location, and mitotic rate at recurrence were the main prescribing decision drivers. Tumor characteristics were the most important factor in achieving CR following c-KIT inhibitor retreatment.

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Acknowledgments

This research was sponsored by the Novartis Pharmaceuticals Corporation, which manufactures imatinib. We thank Ana Bozas, an employee of Analysis Group Inc., who contributed to the preparation and editing of the manuscript.

Ethical Standards

Data used in this study were de-identified; therefore, Institutional Review Board approval was not required. Institutional Review Board exemption was obtained.

Conflict of Interest

Funding for this research was provided by Novartis Pharmaceuticals Corporation. A. Guerin, G. Gauthier, F. Schwiep, and E. Q. Wu are employees of Analysis Group, Inc., which has received consultancy fees from Novartis Pharmaceuticals. M. Sasane and C.H. Keir are employees of Novartis Pharmaceuticals Corporation and hold Novartis stock. A. P. Conley is a clinical researcher at the University of Texas MD Anderson Cancer Center and is acting as a consultant for and receives research support from Novartis Pharmaceuticals Corporation for this project.

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Authors and Affiliations

  1. Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 450, Houston, TX, 77030, USA

    Anthony Paul Conley

  2. Analysis Group, Inc, Boston, MA, USA

    Annie Guerin, Genevieve Gauthier, Frances Schwiep & Eric Q. Wu

  3. Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA

    Medha Sasane & Christopher Hunt Keir

Authors
  1. Anthony Paul Conley
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  2. Annie Guerin
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  3. Medha Sasane
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  4. Genevieve Gauthier
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  5. Frances Schwiep
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  6. Christopher Hunt Keir
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  7. Eric Q. Wu
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Correspondence to Anthony Paul Conley.

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Conley, A.P., Guerin, A., Sasane, M. et al. Treatment Patterns, Prescribing Decision Drivers, and Predictors of Complete Response Following Disease Recurrence in Gastrointestinal Stromal Tumor Patients—a Chart Extract-Based Approach. J Gastrointest Canc 45, 431–440 (2014). https://doi.org/10.1007/s12029-014-9600-4

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  • DOI: https://doi.org/10.1007/s12029-014-9600-4

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