Sunitinib versus imatinib dose escalation after failure of imatinib standard dose in patients with advanced Gastrointestinal stromal tumors - a real-world multi-center study

Shaoqing Huang; Xing Liu; Xiaodan Guo; Hui Wu; Huishan Lu; Zhizhong Pan; Shirong Cai; Xiaojun Wu; Xinhua Zhang

doi:10.1016/j.tranon.2023.101641

Sunitinib versus imatinib dose escalation after failure of imatinib standard dose in patients with advanced Gastrointestinal stromal tumors - a real-world multi-center study

Transl Oncol. 2023 Apr:30:101641. doi: 10.1016/j.tranon.2023.101641. Epub 2023 Feb 13.

Authors

Shaoqing Huang¹, Xing Liu², Xiaodan Guo¹, Hui Wu¹, Huishan Lu³, Zhizhong Pan⁴, Shirong Cai¹, Xiaojun Wu⁵, Xinhua Zhang⁶

Affiliations

¹ Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
² Department of Gastric Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou China.
³ Department of Colorectal Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou China.
⁴ Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China.
⁵ Department of Colorectal Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, China. Electronic address: wuxj@sysucc.org.cn.
⁶ Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Electronic address: zhangxh_sysu@163.com.

Abstract

Background: Whether to escalate imatinib dosage or directly switch to sunitinib in gastrointestinal stromal tumors (GISTs) failing on standard dose 400 mg/d of imatinib is still controversial.

Methods: We evaluated progression-free survival (PFS), overall survival (OS), and time to sunitinib failure (TTSF) of patients selecting imatinib dose escalation or directly switching to sunitinib after the failure of imatinib 400 mg/d therapy from 3 tertery referring centers between January 2008 to December 2016.

Results: A total of 240 patients receiving sunitinib (37.5 mg continuous daily dose or 50 mg 4 weeks on with 2 weeks off) for at least 8 weeks were examined. After failure on imatinib 400 mg/d, 100 (49.3%) patients had dose escalation to 600 mg or 800 mg per day (IM group, imatinib group), and 103 (50.7%) directly switched to sunitinib (SU group, sunitinib group). The PFS in the SU and IM groups was 12 months and 5.0 months (P < 0.001), respectively. TTSF or OS in both groups was not statistically significantly different.

Conclusions: After the progression of imatinib standard-dose treatment in recurrent/metastatic GISTs, the PFS of patients directly switching to sunitinib was significantly longer compared with the PFS of patients with imatinib dose escalation. However, when the patients continued with sunitinib therapy after the failure of IM dose escalation, TTSF and OS in the IM group were similar to those in the SU group. Further exploration of the characteristics of the population benefiting from imatinib dose escalation are warranted.

Keywords: Gastrointestinal stromal tumor (GIST); Imatinib; Overall survival (OS); Progression-free survival (PFS); Sunitinib; Time to sunitinib failure (TTSF).