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Comparative Efficacy and Safety of Different Regimens of Advanced Gastrointestinal Stromal Tumors After Failure Prior Tyrosine Kinase Inhibitors: A Network Meta-Analysis

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The prospect of targeted therapies for advanced gastrointestinal stromal tumors (GISTs) has been dramatically transformed after encouraging results achieved in recent clinical trials. At present, the number of second- and third-line treatments are increasing, although the challenge is to take into account the differences between these interventions. Therefore, our goal is to evaluate the investigation of different regimens currently used in GISTs based on findings from phase II or phase III randomized controlled trials (RCTs), and then indirectly compare the effectiveness and safety of the available therapies.


The qualified literatures in relevant sources were searched systematically. Studies to identify RCTs of which main endpoints were progression-free survival (PFS), overall survival (OS), and grade 3 or more adverse events (AEs) in patients with GISTs were considered for inclusion.


Eight RCTs met our inclusion criteria, which involved 2351 patients. For PFS, compared with placebo, imatinib, and sunitinib, regorafenib (HR = 0.12, 95% CI 0.07–0.23; HR = 0.27, 95% CI 0.19–0.39; HR = 0.36, 95% CI 0.19–0.72, respectively) and ripretinib (HR = 0.15, 95% CI 0.09–0.25; HR = 0.33, 95% CI 0.16–0.68; HR = 0.44, 95% CI 0.25–0.78, respectively) were significantly correlated with the improvement of PFS, and regorafenib may be the preferred option according to the analysis of treatment rankings. For OS, compared with placebo, imatinib, and sunitinib, masitinib (HR = 0.13, 95% CI 0.04–0.44; HR = 0.13, 95% CI 0.04–0.51; HR = 0.27, 95%CI 0.09–0.84) and ripretinib (HR = 0.36, 95% CI 0.21–0.62; HR = 0.36, 95% CI 0.16–0.80; HR = 0.18, 95% CI 0.09–0.36, respectively) were significantly more effective, and masitinib may be the best choice according to treatment ranking analysis. Statistically, regorafenib can be considered to be the highest in high-grade AEs, while the rate of severe AEs of ripretinib and masitinib was likely the lowest.


Our results show that ripretinib has the most favorable balance between effectiveness and tolerability among the different treatment regimens for GISTs.

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All the researchers involved in the study made equal contributions and approved the final manuscript.


The research or publication of this article has received no funding or sponsorship. The processing charges of the article shall be funded by the author.


All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.


Xue Zhang, Yueqin Liang, Yanhua Li, Jiafu Yin have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previous studies and does not include any experiments with human participants or animals performed by any of the authors.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Correspondence to Jiafu Yin.

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Zhang, X., Liang, Y., Li, Y. et al. Comparative Efficacy and Safety of Different Regimens of Advanced Gastrointestinal Stromal Tumors After Failure Prior Tyrosine Kinase Inhibitors: A Network Meta-Analysis. Adv Ther 38, 399–412 (2021).

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