Adherence to Guidelines for Adjuvant Imatinib Therapy for GIST: A Multi-institutional Analysis

Danielle A. Bischof, Rebecca Dodson, M. Carolina Jimenez, Ramy Behman, Andrei Cocieru, Dan G. Blazer, Sarah B. Fisher, Malcolm H. Squires, David A. Kooby, Shishir K. Maithel, Ryan T. Groeschl, T. Clark Gamblin, Todd W. Bauer, Paul J. Karanicolas, Calvin Law, Fayez A. Quereshy, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Adjuvant imatinib therapy improves recurrence-free and overall survival following surgery for patients with high-risk GIST; however, the factors associated with use of adjuvant imatinib therapy are unclear, and adherence to adjuvant imatinib has not been investigated. We sought to determine the clinicopathologic predictors of therapy with adjuvant imatinib following surgical resection for GIST and to determine the utilization of adjuvant imatinib in patients who underwent surgical resection of primary GIST in 2009 or later as recommended by National Comprehensive Cancer network (NCCN) guidelines. Methods: A multi-institutional cohort including 171 patients who underwent surgery for primary GIST at seven high-volume cancer centers in the USA and Canada between January 2009–December 2012 was used in this study. Receipt of adjuvant imatinib therapy was ascertained, and factors associated with imatinib therapy were analyzed. Results: Following surgery for primary GIST, tumor size (10.0 cm: OR 9.15, 95 % CI 2.28–36.75; p = 0.007), mitotic rate (≤5/50 mitoses per 50 high powered field [HPF]: ref; 6–10/50 HPF: OR 24.91, 95 % CI 3.64–170.35; >10/50 HPF: OR 5.80, 95 % CI 3.64–170.35; p <0.001), and neoadjuvant therapy (OR 9.52; 95 % CI 2.51–36.14; p = 0.001) were associated with receipt of adjuvant imatinib therapy. Overall, 75 % of patients received appropriate treatment, 23 % of patients were undertreated, and 2 % of patients were overtreated as compared to NCCN guidelines. Adjuvant imatinib therapy was administered in only 53 % of patients for which the NCCN guidelines recommended adjuvant therapy. Conclusion: The clinicopathologic factors associated with use of adjuvant imatinib therapy in patients following resection of primary GIST are consistent with established risk factors for recurrence. Adjuvant imatinib therapy remains underutilized in patients with intermediate and high-risk GIST and in patients who receive neoadjuvant therapy. Barriers to adjuvant imatinib therapy in this group of patients needs to be further explored.

Original languageEnglish (US)
Pages (from-to)1022-1028
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number6
DOIs
StatePublished - Mar 3 2015

Fingerprint

Guideline Adherence
Gastrointestinal Stromal Tumors
Therapeutics
Neoplasms
Neoadjuvant Therapy
Guidelines
Imatinib Mesylate
Recurrence
Group Psychotherapy
Mitosis
Canada
Gastrointestinal Tract

Keywords

  • Adherence
  • Adjuvant
  • Gastrointestinal stromal tumor
  • GIST
  • Imatinib
  • Surgery
  • Tyrosine kinase inhibitor

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Bischof, D. A., Dodson, R., Jimenez, M. C., Behman, R., Cocieru, A., Blazer, D. G., ... Pawlik, T. M. (2015). Adherence to Guidelines for Adjuvant Imatinib Therapy for GIST: A Multi-institutional Analysis. Journal of Gastrointestinal Surgery, 19(6), 1022-1028. https://doi.org/10.1007/s11605-015-2782-7

Adherence to Guidelines for Adjuvant Imatinib Therapy for GIST : A Multi-institutional Analysis. / Bischof, Danielle A.; Dodson, Rebecca; Jimenez, M. Carolina; Behman, Ramy; Cocieru, Andrei; Blazer, Dan G.; Fisher, Sarah B.; Squires, Malcolm H.; Kooby, David A.; Maithel, Shishir K.; Groeschl, Ryan T.; Gamblin, T. Clark; Bauer, Todd W.; Karanicolas, Paul J.; Law, Calvin; Quereshy, Fayez A.; Pawlik, Timothy M.

In: Journal of Gastrointestinal Surgery, Vol. 19, No. 6, 03.03.2015, p. 1022-1028.

Research output: Contribution to journalArticle

Bischof, DA, Dodson, R, Jimenez, MC, Behman, R, Cocieru, A, Blazer, DG, Fisher, SB, Squires, MH, Kooby, DA, Maithel, SK, Groeschl, RT, Gamblin, TC, Bauer, TW, Karanicolas, PJ, Law, C, Quereshy, FA & Pawlik, TM 2015, 'Adherence to Guidelines for Adjuvant Imatinib Therapy for GIST: A Multi-institutional Analysis', Journal of Gastrointestinal Surgery, vol. 19, no. 6, pp. 1022-1028. https://doi.org/10.1007/s11605-015-2782-7
Bischof, Danielle A. ; Dodson, Rebecca ; Jimenez, M. Carolina ; Behman, Ramy ; Cocieru, Andrei ; Blazer, Dan G. ; Fisher, Sarah B. ; Squires, Malcolm H. ; Kooby, David A. ; Maithel, Shishir K. ; Groeschl, Ryan T. ; Gamblin, T. Clark ; Bauer, Todd W. ; Karanicolas, Paul J. ; Law, Calvin ; Quereshy, Fayez A. ; Pawlik, Timothy M. / Adherence to Guidelines for Adjuvant Imatinib Therapy for GIST : A Multi-institutional Analysis. In: Journal of Gastrointestinal Surgery. 2015 ; Vol. 19, No. 6. pp. 1022-1028.
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title = "Adherence to Guidelines for Adjuvant Imatinib Therapy for GIST: A Multi-institutional Analysis",
abstract = "Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Adjuvant imatinib therapy improves recurrence-free and overall survival following surgery for patients with high-risk GIST; however, the factors associated with use of adjuvant imatinib therapy are unclear, and adherence to adjuvant imatinib has not been investigated. We sought to determine the clinicopathologic predictors of therapy with adjuvant imatinib following surgical resection for GIST and to determine the utilization of adjuvant imatinib in patients who underwent surgical resection of primary GIST in 2009 or later as recommended by National Comprehensive Cancer network (NCCN) guidelines. Methods: A multi-institutional cohort including 171 patients who underwent surgery for primary GIST at seven high-volume cancer centers in the USA and Canada between January 2009–December 2012 was used in this study. Receipt of adjuvant imatinib therapy was ascertained, and factors associated with imatinib therapy were analyzed. Results: Following surgery for primary GIST, tumor size (10.0 cm: OR 9.15, 95 {\%} CI 2.28–36.75; p = 0.007), mitotic rate (≤5/50 mitoses per 50 high powered field [HPF]: ref; 6–10/50 HPF: OR 24.91, 95 {\%} CI 3.64–170.35; >10/50 HPF: OR 5.80, 95 {\%} CI 3.64–170.35; p <0.001), and neoadjuvant therapy (OR 9.52; 95 {\%} CI 2.51–36.14; p = 0.001) were associated with receipt of adjuvant imatinib therapy. Overall, 75 {\%} of patients received appropriate treatment, 23 {\%} of patients were undertreated, and 2 {\%} of patients were overtreated as compared to NCCN guidelines. Adjuvant imatinib therapy was administered in only 53 {\%} of patients for which the NCCN guidelines recommended adjuvant therapy. Conclusion: The clinicopathologic factors associated with use of adjuvant imatinib therapy in patients following resection of primary GIST are consistent with established risk factors for recurrence. Adjuvant imatinib therapy remains underutilized in patients with intermediate and high-risk GIST and in patients who receive neoadjuvant therapy. Barriers to adjuvant imatinib therapy in this group of patients needs to be further explored.",
keywords = "Adherence, Adjuvant, Gastrointestinal stromal tumor, GIST, Imatinib, Surgery, Tyrosine kinase inhibitor",
author = "Bischof, {Danielle A.} and Rebecca Dodson and Jimenez, {M. Carolina} and Ramy Behman and Andrei Cocieru and Blazer, {Dan G.} and Fisher, {Sarah B.} and Squires, {Malcolm H.} and Kooby, {David A.} and Maithel, {Shishir K.} and Groeschl, {Ryan T.} and Gamblin, {T. Clark} and Bauer, {Todd W.} and Karanicolas, {Paul J.} and Calvin Law and Quereshy, {Fayez A.} and Pawlik, {Timothy M.}",
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TY - JOUR

T1 - Adherence to Guidelines for Adjuvant Imatinib Therapy for GIST

T2 - A Multi-institutional Analysis

AU - Bischof, Danielle A.

AU - Dodson, Rebecca

AU - Jimenez, M. Carolina

AU - Behman, Ramy

AU - Cocieru, Andrei

AU - Blazer, Dan G.

AU - Fisher, Sarah B.

AU - Squires, Malcolm H.

AU - Kooby, David A.

AU - Maithel, Shishir K.

AU - Groeschl, Ryan T.

AU - Gamblin, T. Clark

AU - Bauer, Todd W.

AU - Karanicolas, Paul J.

AU - Law, Calvin

AU - Quereshy, Fayez A.

AU - Pawlik, Timothy M.

PY - 2015/3/3

Y1 - 2015/3/3

N2 - Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Adjuvant imatinib therapy improves recurrence-free and overall survival following surgery for patients with high-risk GIST; however, the factors associated with use of adjuvant imatinib therapy are unclear, and adherence to adjuvant imatinib has not been investigated. We sought to determine the clinicopathologic predictors of therapy with adjuvant imatinib following surgical resection for GIST and to determine the utilization of adjuvant imatinib in patients who underwent surgical resection of primary GIST in 2009 or later as recommended by National Comprehensive Cancer network (NCCN) guidelines. Methods: A multi-institutional cohort including 171 patients who underwent surgery for primary GIST at seven high-volume cancer centers in the USA and Canada between January 2009–December 2012 was used in this study. Receipt of adjuvant imatinib therapy was ascertained, and factors associated with imatinib therapy were analyzed. Results: Following surgery for primary GIST, tumor size (10.0 cm: OR 9.15, 95 % CI 2.28–36.75; p = 0.007), mitotic rate (≤5/50 mitoses per 50 high powered field [HPF]: ref; 6–10/50 HPF: OR 24.91, 95 % CI 3.64–170.35; >10/50 HPF: OR 5.80, 95 % CI 3.64–170.35; p <0.001), and neoadjuvant therapy (OR 9.52; 95 % CI 2.51–36.14; p = 0.001) were associated with receipt of adjuvant imatinib therapy. Overall, 75 % of patients received appropriate treatment, 23 % of patients were undertreated, and 2 % of patients were overtreated as compared to NCCN guidelines. Adjuvant imatinib therapy was administered in only 53 % of patients for which the NCCN guidelines recommended adjuvant therapy. Conclusion: The clinicopathologic factors associated with use of adjuvant imatinib therapy in patients following resection of primary GIST are consistent with established risk factors for recurrence. Adjuvant imatinib therapy remains underutilized in patients with intermediate and high-risk GIST and in patients who receive neoadjuvant therapy. Barriers to adjuvant imatinib therapy in this group of patients needs to be further explored.

AB - Background: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Adjuvant imatinib therapy improves recurrence-free and overall survival following surgery for patients with high-risk GIST; however, the factors associated with use of adjuvant imatinib therapy are unclear, and adherence to adjuvant imatinib has not been investigated. We sought to determine the clinicopathologic predictors of therapy with adjuvant imatinib following surgical resection for GIST and to determine the utilization of adjuvant imatinib in patients who underwent surgical resection of primary GIST in 2009 or later as recommended by National Comprehensive Cancer network (NCCN) guidelines. Methods: A multi-institutional cohort including 171 patients who underwent surgery for primary GIST at seven high-volume cancer centers in the USA and Canada between January 2009–December 2012 was used in this study. Receipt of adjuvant imatinib therapy was ascertained, and factors associated with imatinib therapy were analyzed. Results: Following surgery for primary GIST, tumor size (10.0 cm: OR 9.15, 95 % CI 2.28–36.75; p = 0.007), mitotic rate (≤5/50 mitoses per 50 high powered field [HPF]: ref; 6–10/50 HPF: OR 24.91, 95 % CI 3.64–170.35; >10/50 HPF: OR 5.80, 95 % CI 3.64–170.35; p <0.001), and neoadjuvant therapy (OR 9.52; 95 % CI 2.51–36.14; p = 0.001) were associated with receipt of adjuvant imatinib therapy. Overall, 75 % of patients received appropriate treatment, 23 % of patients were undertreated, and 2 % of patients were overtreated as compared to NCCN guidelines. Adjuvant imatinib therapy was administered in only 53 % of patients for which the NCCN guidelines recommended adjuvant therapy. Conclusion: The clinicopathologic factors associated with use of adjuvant imatinib therapy in patients following resection of primary GIST are consistent with established risk factors for recurrence. Adjuvant imatinib therapy remains underutilized in patients with intermediate and high-risk GIST and in patients who receive neoadjuvant therapy. Barriers to adjuvant imatinib therapy in this group of patients needs to be further explored.

KW - Adherence

KW - Adjuvant

KW - Gastrointestinal stromal tumor

KW - GIST

KW - Imatinib

KW - Surgery

KW - Tyrosine kinase inhibitor

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