Clinical Research Papers:
Imatinib dose escalation versus sunitinib as a second-line treatment against advanced gastrointestinal stromal tumors: A nationwide population-based cohort study
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Jun-Te Hsu1, Puo-Hsien Le2, Chang-Fu Kuo3, Meng-Jiun Chiou4, Chia-Jung Kuo2, Tsung-Hsing Chen2, Chun-Jung Lin2, Jen-Shi Chen5, Huang-Pin Yu6, Chun-Nan Yeh1, Yi-Yin Jan1, Ta-Sen Yeh1
1Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
2Department of Gastroenterology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
3Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
4Office for Big Data Research, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
5Department of Hemato-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
6Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
Jun-Te Hsu, email: email@example.com
Chun-Nan Yeh, email: firstname.lastname@example.org
Keywords: gastrointestinal stromal tumor, imatinib, sunitinib, dose escalation, survival
Received: January 12, 2017 Accepted: March 22, 2017 Published: April 03, 2017
Background: Although treatment with imatinib in advanced gastrointestinal stromal tumor (GIST) patients has led to significant clinical benefits, the disease will eventually progress due to imatinib resistance. Treatment options after failure of first-line imatinib include imatinib dose escalation or shifting to sunitinib. However, there is no large-scale study to compare the efficacy difference between these two treatment strategies or the role of surgery.
Results: This study recruited 521 advanced GIST patients including 246, 125, and 150 placed in groups 1, 2, and 3, respectively. Groups 1 and 2 had significantly longer overall survival (OS) as compared with the group 3 (median 37.5 months versus 16.0 months; p < 0.0001). After adjusting for confounding variables, groups 1 and 2 had longer OS than group 3. A favorable survival trend was seen with surgery, although this benefit disappeared after adjusting for confounding factors.
Materials and Methods: We conducted a nationwide population-based cohort study using data from the Taiwan National Health Insurance Research Database from July 2004 to December 2010. Advanced GIST patients who no longer responded to first-line imatinib were stratified into three groups: imatinib dose escalation (group 1); imatinib dose escalation and a shift to sunitinib (group 2); a direct shift to sunitinib (group 3). The therapeutic success of the three treatment regimens and the effect of surgery were evaluated by overall survival.
Conclusions: For advanced GIST patients who failed first-line imatinib treatment, imatinib dose escalation confers significantly longer OS compared to a direct switch to sunitinib. Surgery does not provide survival benefits.
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