Gastrointestinal stromal tumor in North Africa and the middle east: updates in presentation and management from an 11-year retrospective cohort

ABSTRACT

Objectives

This study described the epidemiological, clinical, and survival profiles of patients with gastrointestinal stromal tumor (GIST) in North Africa and the Middle East (AfME).

Methods

This regional, multicenter, observational, retrospective study collected 11-year data on demographics, medical history, disease characteristics, current treatment approaches of GIST, the safety of the most common tyrosine kinase inhibitors (TKIs), second cancers, and survival status.

Results

Data of 201 eligible patients were analyzed: mean age was 56.9 ± 12.6 years; 111 (55.2%) patients were men, 21 (10.4%) patients had previous personal malignancy. The most common clinical presentation of GIST was dysphagia [92 (45.8%) patients]. The stomach was the most common primary site in 120 (60.7%) patients, 171 (85.1%) patients had localized disease at diagnosis. 198 (98.5%) GIST cases were CD117/CD34-positive. Imatinib was used in the neoadjuvant (18/21 patients), adjuvant (85/89 patients), and first-line metastatic treatment (28/33 patients) settings. The most common non-hematological toxicity associated with TKIs was vomiting in 32/85 (37.6%) patients. Overall, 100 (49.8%) patients (95%CI: 42.8–56.7%) were alive and disease-free while 30 (14.9%) patients were alive with active disease.

Conclusion

Presentation of GIST in our AfME population is consistent with global reports, being more frequent in patients >50 years old and having the stomach as the most common primary site. Unlike what is usually reported, though, we did have more patients with lymphatic spread of the disease. Despite the global trend and advances in the treatment of GIST according to molecular profile, this is still far to happen in our population given the lack of access to molecular profiles and the high associated cost.

KEYWORDS:

• Diagnosis
• epidemiology
• gastrointestinal stromal tumor (GIST)
• markers
• mutational analyses
• tyrosine kinase inhibitors

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Racha Aaraj, Pharm D, MSc, MPH from Phoenix Clinical Research, Lebanon provided editorial and medical writing assistance for the preparation of this manuscript based on the Good Publication Practice (GPP 2022) and the ICMJE requirements; this assistance was funded by the Africa Middle East Cancer Intergroup (AMCI).

Author contributions

F Farhat: study conception and design, medical management of patients, laboratory assessments, data collection, data analysis, manuscript writing, and approval. M Hussein: medical management of patients, laboratory assessments, data collection, manuscript writing, and approval. E Sbaity: medical management of patients, laboratory assessments, data collection, manuscript writing, and approval. A Alsharm: medical management of patients, laboratory assessments, data collection, manuscript writing, and approval. K Rasul: medical management of patients, laboratory assessments, data collection, manuscript writing, and approval. S Khairallah: cytology, molecular pathology, data collection, manuscript writing, and approval. T Assi: data collection, data analysis, manuscript writing, and approval. N Allahyerdi: laboratory assessments, data collection, manuscript approval. A Othman: medical management of patients, laboratory assessments, data collection, manuscript writing, and approval. J Kattan: medical management of patients, laboratory assessments, data collection, data analysis, manuscript writing, and approval. All authors reviewed and approved the manuscript.

Data availability statement

The data that support the findings of this study are available from the corresponding author, Fadi Farhat, upon reasonable request.

Additional information

Funding

This work was supported by the Africa Middle East Cancer Intergroup (AMCI). The authors retained the editorial process, including the discussion at all times. There was no financial reward associated with writing the paper. The views and opinions expressed are those of the authors.