Comprehensive review into the challenges of gastrointestinal tumors in the Gulf and Levant countries

Rare Tumors Gi GroupFadi Farhat 1Abdulaziz Al Farsi 2Ahmed Mohieldin 3Bassim Al Bahrani 2Eman Sbaity 4Hassan Jaffar 5Joseph Kattan 6Kakil Rasul 7Khairallah Saad 8Tarek Assi 9Waleed El Morsi 10Rafid A Abood 11

Affiliations

1Hammoud Hospital UMC, Saida PO Box 652, Lebanon. drfadifarhat@hammoudhospital.com.

2Medical Oncology Department, Royal Hospital, Muscat PO Box 1331, Oman.

3Medical Oncology Department, Kuwait Cancer Control Center, Kuwait PO Box 42262, Kuwait.

4Division of General Surgery, American University of Beirut, Beirut 1107 2180, Lebanon.

5Oncology Department, Tawam Hospital, Al Ain PO Box 15258, United Arab Emirates.

6Hemato-oncology Department, Hotel Dieu de France, Beirut, Lebanon.

7Hemato-oncology Department, National Center for Cancer Care and Research, Doha, Qatar.

8Pathology Department, Institute National de Pathologic, Beirut, Lebanon.

9Oncology Department, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.

10Pfizer Oncology-Emerging Markets, Dubai Media City, Dubai, United Arab Emirates.

11Oncology Department, Basra College of Medicine, Basra, Iraq.

PMID: 32110658

PMCID: PMC7031830

DOI: 10.12998/wjcc.v8.i3.487

Free PMC article

Abstract

Although gastrointestinal stromal tumors (GISTs) are rare, with an incidence of 1/100000 per year, they are the most common sarcomas in the peritoneal cavity. Despite considerable progress in the diagnosis and treatment of GIST, about half of all patients are estimated to experience recurrence. With only two drugs, sunitinib and regorafenib, approved by the Food and Drug Administration, selecting treatment options after imatinib failure and coordinating multidisciplinary care remain challenging. In addition, physicians across the Middle East face some additional and unique challenges such as lack of published local data from clinical trials, national disease registries and regional scientific research, limited access to treatment, lack of standardization of care, and limited access to mutational analysis. Although global guidelines set a framework for the management of GIST, there are no standard local guidelines to guide clinical practice in a resource-limited environment. Therefore, a group of 11 experienced medical oncologists from across the Gulf and Levant region, part of the Rare Tumors Gastrointestinal Group, met over a period of one year to conduct a narrative review of the management of GIST and to describe regional challenges and gaps in patient management as an essential step to proposing local clinical practice recommendations.

Keywords: Challenges; Diagnosis; Disease management; Gastrointestinal stromal tumors; Middle East; Treatment.

Conflict of interest statement

Conflict-of-interest statement: Fadi Farhat, Adbulaziz Al Farsi, Ahmed Mohieldin, Eman Sbaity, Hassan Jaffar, Joseph Kattan, Kakil Rasul, Khairallah Saad, Tarek Assi and Rafid A Abood have no conflicts of interest to declare. Bassim Al Bahrani received advisor honoraria from Merck, Roche, Amgen, AstraZeneca, Biocon, BMS, Hospira, Lilly, Sanofi, MSD, Pfizer, Novartis, Bayer; and speaker/chairperson honoraria from Amgen, AstraZeneca, BMS, GSK, Hospira, Lilly, Novartis, Pfizer, Roche, Sanofi, MSD, Newbridge. Waleed El Morsi is an employee of Pfizer. Travel expenses for physician attendance at the Rare Tumors GI Group meetings and medical writing support were funded by Pfizer Pharmaceuticals Middle East, Dubai, United Arab Emirates.

Five-year recurrence-free survival and overall survival. A: Five-year recurrence-free survival and overall survival at a median follow-up of 54 mo with 3-year vs 1-year imatinib adjuvant treatment in patients with resected gastrointestinal stromal tumors estimated to be at high risk of recurrence[39]. B: Five-year recurrence-free survival and overall survival at a median follow-up of 90 mo with 3-year vs 1-year imatinib adjuvant treatment in patients with resected gastrointestinal stromal tumors estimated to be at high risk of recurrence[40]. OS: Overall survival; RFS: Recurrence-free survival.
Algorithm for the management of localized primary gastrointestinal stromal tumors. CT: Computed tomography; GI: Gastrointestinal; GIST: Gastrointestinal stromal tumors; MRI: Magnetic resonance imaging; R0: No residual tumor; R1: Microscopic residual tumor.