A Systematic Literature Review (SLR) of Clinical Practice Guidelines (CPGS) and Real-World Treatment Patterns in Metastatic Gastrointestinal Stromal Tumours (MGISTS) in Europe


Mittal R1, Aggarwal T1, Verma R2, Ahuja A3
1Lumanity, Gurgaon, DL, India, 2Lumanity, Delhi, DL, India, 3Lumanity, Chandigarh, CH, India

Presentation Documents

OBJECTIVES: This systematic literature review aimed to identify treatment recommendations based on clinical practice guidelines (CPGs) and to understand real-world patterns of care for metastatic gastrointestinal stromal tumours (mGISTs).

METHODS: We searched Embase® and MEDLINE® to identify relevant post-2012 English language publications providing CPGs and real-world treatment patterns in patients with mGISTs.

RESULTS: Of the 1032 records screened, 24 studies met the inclusion criteria (treatment patterns: 18 studies and CPGs: 6 studies). Two guidelines were identified for Europe, two for Spain and one each for Germany and France. To treat mGISTs all CPGs have a standard recommendation of imatinib as first-line treatment followed by sunitinib as second-line and regorafenib as third line. European Society for Medical Oncology guidelines prefer avapritinib at first line for patients with imatinib-non-sensitive mutation. In the first-line setting, guidelines recommend continuing imatinib indefinitely until disease progression or intolerance. This avoids rapid tumour progression and highlights the importance of patient compliance to therapy. Real-world treatment patterns also show that imatinib is the first-line treatment of choice (86.1–99.2%). However, for further lines of therapy there is some discord against treatment guidelines with sunitinib (administered in 17.6% [France]–100% [Netherlands] patients) and regorafenib (10.5%–76% patients) not always being physicians’ second- and third-line treatment of choice. Strikingly, imatinib was also given as second-line choice (France 100%; Italy 26.8%) as well as third- to sixth-line choice in 9%–53% of patients. Other therapeutic options for subsequent lines of therapy included avapritinib, cabozantinib and nilotinib.

CONCLUSIONS: European CPGs recommend imatinib, sunitinib and regorafenib as first- second- and third-line treatment options for mGISTs. There is concordance between both real-word treatment patterns and CPGs’ recommendations for first-line treatment (i.e. imatinib). However, in real-world settings recommendations for subsequent lines are not always adhered to. Further research is needed to address these differences.

Conference/Value in Health Info

2022-11, ISPOR Europe 2022, Vienna, Austria

Value in Health, Volume 25, Issue 12S (December 2022)




Real World Data & Information Systems, Study Approaches

Topic Subcategory

Distributed Data & Research Networks, Literature Review & Synthesis


SDC: Oncology

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