2022
DOI: 10.3389/fphar.2022.978885
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A systematic review and network meta-analysis of the efficacy and safety of third-line and over third-line therapy after imatinib and TKI resistance in advanced gastrointestinal stromal tumor

Abstract: Tyrosine kinase inhibitors (TKIs) have greatly improved the prognosis of unresectable and metastatic gastrointestinal stromal tumors (GISTs) in the last two decades. Imatinib and sunitinib are recommended as first-line and second-line therapies, respectively. However, there is a lack of precision therapy for refractory GISTs regarding therapy after imatinib and sunitinib. We comprehensively searched electronic databases, including PubMed, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials, from incep… Show more

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Cited by 3 publications
(3 citation statements)
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“…While there are no head-to-head trials in the fourth line, a specific profile of adverse events of ripretinib (alopecia) and pimitespib (night blindness) was also reported [ 84 , 85 ]. A meta-analysis suggested nilotinib and pimitespib as the treatment with the most tolerable side-effect profile in the third line or beyond [ 87 ].…”
Section: Discussionmentioning
confidence: 99%
See 1 more Smart Citation
“…While there are no head-to-head trials in the fourth line, a specific profile of adverse events of ripretinib (alopecia) and pimitespib (night blindness) was also reported [ 84 , 85 ]. A meta-analysis suggested nilotinib and pimitespib as the treatment with the most tolerable side-effect profile in the third line or beyond [ 87 ].…”
Section: Discussionmentioning
confidence: 99%
“…While avapritinib was allowed in the various lines of treatment in the original NAVIGATOR trial, including the first line of treatment [ 43 , 44 ], an analysis of Chinese patients who most commonly received avapritinib in the fourth line of treatment or beyond (34%) resulted in a similar efficacy, with a clinical benefit rate of 86% (24/28) in patients with PDGFRA D842V mutation and a PFS of 5.6 months, with immature OS data [ 86 ]. A network meta-analysis, which has evaluated the efficacy and safety of third-line and over-third-line therapy, has placed ripretinib as the best drug for PFS, OS, and disease control rate, whereas nilotinib and pimitespib were shown to have more tolerable side-effects [ 87 ].…”
Section: Fourth-line Treatment Of Metastatic or Unresectable Gistmentioning
confidence: 99%
“…Xiao and colleagues, by meta-analysis on several databases, analyzed seven randomized controlled trials testing seven different TKIs. Comparing third-line or over-third-line therapies to assess the most active drugs against GISTs, they found that ripretinib is more effective than other drugs with respect to PFS, exhibiting good efficacy, and also for the over-third-line therapy [ 152 ].…”
Section: Fourth-line Therapy For Resistant Gistsmentioning
confidence: 99%