Systematic review of the clinical and cost-effectiveness of imatinib at escalated doses of 600 mg/day or 800 mg/day for the treatment of unresectable and/or metastatic gastrointestinal stromal tumours which have progressed on treatment at a dose of 400 mg/day

Summary

This study was a technology assessment review funded by the NIHR Health Technology Assessment programme.  We conducted a systematic review of evidence on the effectiveness of imatinib at escalated doses of 600 mg/day or 800 mg/day for treatment of adults with unresectable or metastatic gastrointestinal stromal tumours (GIST), following progression on imatinib at the 400 mg/day dose, compared with sunitinib and/or ‘best supportive care’. We found that median overall survival for imatinib (800 mg/day) and sunitinib were both were less than 2 years. Around 25% of patients required either an imatinib dose delay or reduction. Approximately one-third of patients receiving dose escalated imatinib (either dose) showed either response or stable disease. Amongst those responding to the escalated 800 mg/day dose, median progression-free survival was over 25 months.  We concluded that a prospective audit of management and outcomes for unresectable GIST patients would be appropriate.

Contact

Andrew Elders; andrew.elders@abdn.ac.uk

Status

Completed

Publications

Hislop J, Mowatt G, Sharma P, Fraser C, Elders A, Jenkinson D, Vale L, Petty R (2012). Systematic review of escalated imatinib doses compared with sunitinib or best supportive care, for the treatment of people with unresectable/metastatic gastrointestinal stromal tumours whose disease has progressed on the standard imatinib dose. Journal of Gastrointestinal Cancer, 43(2), 168-176.

Hislop J, Quayyum Z, Elders A, Fraser C, Jenkinson D, Mowatt G, Sharma P, Vale L, Petty R (2011).  Clinical effectiveness and cost-effectiveness of imatinib dose escalation for the treatment of unresectable and/or metastatic gastrointestinal stromal tumours that have progressed on treatment at a dose of 400 mg/day: a systematic review and economic evaluation. Health Technology Assessment, 15(25), 1-178.

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