Underuse of exon mutational analysis for gastrointestinal stromal tumors.

MedStar author(s):
Citation: Journal of Surgical Research. 231:43-48, 2018 Nov.PMID: 30278964Institution: MedStar Health Research Institute | MedStar Washington Hospital CenterDepartment: Surgery/General SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *DNA Mutational Analysis/sn [Statistics & Numerical Data] | *Gastrointestinal Neoplasms/ge [Genetics] | *Gastrointestinal Stromal Tumors/ge [Genetics] | *Health Services Misuse | Adult | Aged | Antineoplastic Agents/pd [Pharmacology] | Antineoplastic Agents/tu [Therapeutic Use] | Exons/ge [Genetics] | Female | Gastrointestinal Neoplasms/dt [Drug Therapy] | Gastrointestinal Stromal Tumors/dt [Drug Therapy] | Humans | Male | Middle Aged | Protein-Tyrosine Kinases/ai [Antagonists & Inhibitors] | Retrospective StudiesYear: 2018ISSN:
  • 0022-4804
Name of journal: The Journal of surgical researchAbstract: BACKGROUND: Tyrosine kinase inhibitors (TKI) have become the guideline-recommended therapy for high-risk resected and advanced gastrointestinal stromal tumors (GISTs). Exon mutational analysis (EMA) is used to inform pretherapy response to TKI and may predict overall prognosis. Despite these benefits, EMA remains underused, and its impact on TKI therapy decision-making remains unexplored.CONCLUSIONS: Less than half of patients receiving TKI therapy for GISTs received EMA at a comprehensive cancer center. Despite this low uptake, when it was performed, EMA guided alternative treatment decision in 41% of patients. Physician survey responses indicated that interventions targeting physician education and an electronic medical record reminder may improve EMA uptake.Copyright (c) 2018 Elsevier Inc. All rights reserved.MATERIALS AND METHODS: A retrospective cohort was established from 104 patients receiving treatment for GISTs from 2006 to 2017. Current National Comprehensive Cancer Network guidelines indicate that EMA should be considered for all patients undergoing TKI therapy to identify genotypes that are likely, or unlikely, to respond to treatment. We first tracked guideline-considered EMA use and subsequent impact on treatment decision-making. A questionnaire was then administered to gastrointestinal medical oncologists to assess EMA perception.RESULTS: Among 104 GIST patients, 54 (52%) received TKI therapy. Of these, only 22 (41%) received EMA. Informed by EMA, treatment decisions included 59% who continued with original TKI therapy, 32% who switched to an alternative TKI, and 9% who discontinued or received no TKI. Although 92% of physicians indicated EMA was a valuable tool, only 62% indicated they used it "frequently" or "always" to inform treatment decisions.All authors: Al-Refaie WB, Bartholomew AJ, Dohnalek H, Haddad NG, Marshall JL, O'Neill SC, Prins PA, Quadri HSFiscal year: FY2019Digital Object Identifier: Date added to catalog: 2018-10-10
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Journal Article MedStar Authors Catalog Article 30278964 Available 30278964

BACKGROUND: Tyrosine kinase inhibitors (TKI) have become the guideline-recommended therapy for high-risk resected and advanced gastrointestinal stromal tumors (GISTs). Exon mutational analysis (EMA) is used to inform pretherapy response to TKI and may predict overall prognosis. Despite these benefits, EMA remains underused, and its impact on TKI therapy decision-making remains unexplored.

CONCLUSIONS: Less than half of patients receiving TKI therapy for GISTs received EMA at a comprehensive cancer center. Despite this low uptake, when it was performed, EMA guided alternative treatment decision in 41% of patients. Physician survey responses indicated that interventions targeting physician education and an electronic medical record reminder may improve EMA uptake.

Copyright (c) 2018 Elsevier Inc. All rights reserved.

MATERIALS AND METHODS: A retrospective cohort was established from 104 patients receiving treatment for GISTs from 2006 to 2017. Current National Comprehensive Cancer Network guidelines indicate that EMA should be considered for all patients undergoing TKI therapy to identify genotypes that are likely, or unlikely, to respond to treatment. We first tracked guideline-considered EMA use and subsequent impact on treatment decision-making. A questionnaire was then administered to gastrointestinal medical oncologists to assess EMA perception.

RESULTS: Among 104 GIST patients, 54 (52%) received TKI therapy. Of these, only 22 (41%) received EMA. Informed by EMA, treatment decisions included 59% who continued with original TKI therapy, 32% who switched to an alternative TKI, and 9% who discontinued or received no TKI. Although 92% of physicians indicated EMA was a valuable tool, only 62% indicated they used it "frequently" or "always" to inform treatment decisions.

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