Pan-Canadian consensus recommendations for GIST management in high- and low-throughput centres across Canada

J Robert Beecroft; Savtaj Brar; Xiaolan Feng; Trevor Hamilton; Cheng Han-Lee; Jan-Willem Henning; P David Josephy; Korosh Khalili; Yoo-Joung Ko; Christopher Lemieux; David M Liu; D Blair MacDonald; Jonathan Noujaim; Aaron Pollett; Abdulazeez Salawu; Ramy Saleh; Alannah Smrke; Blair E Warren; Kevin Zbuk; Albiruni Abdul Razak

doi:10.1177/17588359241266179

Pan-Canadian consensus recommendations for GIST management in high- and low-throughput centres across Canada

Ther Adv Med Oncol. 2024 Aug 2:16:17588359241266179. doi: 10.1177/17588359241266179. eCollection 2024.

Authors

J Robert Beecroft¹, Savtaj Brar², Xiaolan Feng³, Trevor Hamilton⁴, Cheng Han-Lee⁵, Jan-Willem Henning⁶, P David Josephy⁷, Korosh Khalili⁸, Yoo-Joung Ko⁹, Christopher Lemieux¹⁰, David M Liu^{11

12}, D Blair MacDonald¹³, Jonathan Noujaim¹⁴, Aaron Pollett^{15

16}, Abdulazeez Salawu¹⁷, Ramy Saleh¹⁸, Alannah Smrke¹⁹, Blair E Warren²⁰, Kevin Zbuk²¹, Albiruni Abdul Razak²²

Affiliations

¹ Division of Interventional Radiology, Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, Toronto, ON, Canada.
² Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
³ Division of Medical Oncology, Tom Baker Cancer Center, Calgary, AB, Canada.
⁴ Department of Surgery, BC Cancer, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
⁵ Department of Laboratory Medicine & Pathology, University of Alberta, Edmonton, AB, Canada.
⁶ Department of Oncology, Tom Baker Cancer Centre, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁷ GIST Sarcoma Life Raft Group Canada, Guelph, ON, Canada.
⁸ Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada.
⁹ Department of Medicine, St. Michael's Hospital, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada.
¹⁰ Division of Hematology and Medical Oncology, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada.
¹¹ Department of Radiology, University of British Columbia, School of Biomedical Engineering, Vancouver, BC, Canada.
¹² Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL, USA.
¹³ Department of Medical Radiology, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
¹⁴ Division of Medical Oncology, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, QC, Canada.
¹⁵ Pathology and Laboratory Medicine, Division of Diagnostic Medical Genetics, Mount Sinai Hospital, Toronto, ON, Canada.
¹⁶ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
¹⁷ Division of Medical Oncology, Princess Margaret Cancer Centre, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
¹⁸ Division of Medical Oncology, McGill University Health Centre, Montreal, Quebec, Canada.
¹⁹ Division of Medical Oncology, BC Cancer, University of British Columbia, Vancouver, BC, Canada.
²⁰ Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
²¹ Department of Oncology, McMaster University, Hamilton, ON, Canada.
²² Division of Medical Oncology, Princess Margaret Cancer Centre, Mount Sinai Hospital, University of Toronto, 610 University Ave., Toronto, ON M2G 2M9, Canada.

Abstract

Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours that originate from the interstitial cells of Cajal. GISTs are mainly driven by gain-of-function mutations in receptor tyrosine kinase or platelet-derived growth factor receptor alpha. Surgical resection is the only curative treatment for localized tumours and all currently approved medical GIST treatments are based on orally available tyrosine kinase inhibitors. Recent discoveries in the molecular and clinical features of GISTs have greatly impacted GIST management. Due to the provincially rather than nationally administered Canadian healthcare system, there have been inconsistencies in the treatment of GISTs across the country. Therefore, guidance on the latest knowledge, clinical management and treatment of GIST is needed to standardize the approach to GIST management nationwide. To establish pan-Canadian guidance, provide up-to-date data and harmonize the clinical practice of GIST management in high- and low-throughput centres across Canada; a panel of 20 physicians with extensive clinical experience in GIST management reviewed relevant literature. This included radiologists, pathologists, interventional radiologists, surgeons and medical oncologists across Canada. The structured literature focused on seven key domains: molecular profiling, radiological techniques/reporting, targeted localized therapy, intricacies of systemic treatments, emerging tests, multidisciplinary care and patient advocacy. This literature review, along with clinical expertise and opinion, was used to develop this concise and clinically relevant consensus paper to harmonize the knowledge and clinical practice on GIST management across Canada. The content presented here will help guide healthcare providers, especially in Canada, in terms of approaching and managing GIST.

Keywords: CECT; Canada; DOG1; GIST; GIST management; KIT; PDGFRA; TKIs; advocacy; avapritinib; consensus based; contrast-enhanced CT scan; ctDNA; gastrointestinal; gastrointestinal stromal tumour; imatinib; imatinib resistance; locoregional therapies; mesenchymal; molecular testing; multidisciplinary; mutation; progression; regorafenib; ripretinib; sarcoma; specialized centres; sunitinib; surgery; tertiary centres; tyrosine kinase receptor inhibitors.

Publication types

Review