الفهرس 
Introduction & aim of the workOnly 14 pages are availabe for public view
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Abstract
Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumor located in the gastrointestinal (GI) tract. characteristically, most GISTs (> 95%) are positive for KIT (CD117) protein staining. Imatinib (also known as “Gleevec” or “Glivec”), a tyrosine kinase inhibitor, was called as “magical bullet,” when it revolutionized the treatment of chronic myeloid leukemia (CML) in 2001. After CML, Imatinib dramatically altered both the management and prognosis for GIST. Nevertheless, there is still scarcity in the published literature regarding the efficacy and safety of different regimens of Imatinib in GIST. Therefore, we conducted the present systematic review and meta-analysis in order to evaluate the efficacy and safety of adjuvant Imatinib in patients with high-risk GISTs.
In the present study, we searched Medline via PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from their inception till February 2019. A total of 10 studies (Total No. of patients =3798) were included; 5 studies were RCTs, while the rest of the studies were prospective study with historical controls.
In the present systematic review, the average age of the patients within the included studies ranged from 55-67 years old and there was a slight male predominance in the included studies. Five included studies assessed adjuvant Imatinib 400mg versus no treatment, the overall effect estimates favored Imatinib 400mg compared to no treatment in term of recurrent-free survival (OR 18.33, 95% CI [5.43, 356.43], p <0.001) and overall survival (OR 7.28, 95% CI [5.05, 10.51], p <0.001). We showed that the overall effect estimates favored Imatinib 800mg compared to 400mg in term of progressing-free survival (OR 0.54, 95% CI [0.44, 0.66], p <0.001). However, there was no difference in overall survival (OR 0.84, 95% CI [0.66, 1.06], p =0.15). In the present meta-analysis, three included studies assessed Imatinib for one year versus 3 years, the overall effect estimates favored Imatinib for 3 years compared to one year in term of recurrent-free survival (OR 2.18, 95% CI [1.64, 2.89], p <0.001) and overall survival (OR 2.44, 95% CI [1.52, 3.91], p <0.001).
In conclusion, the present systematic review and meta-analysis showed that adjuvant Imatinib is effective in patients with high risk GISTs, with tolerable safety profile.
The meta-analysis results showed that Imatinib significantly improved the overall survival and progression-free survival; and did not increase the risk of severe adverse events. In addition, higher dose (800mg) and longer duration (3 years) of Imatinib appears to be more effective than the standardized regimen. Nevertheless, the currently published literature lacks high quality trials and further studies are still needed to confirm our finding.