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Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2020; 8(3): 487-503
Published online Feb 6, 2020. doi: 10.12998/wjcc.v8.i3.487
Comprehensive review into the challenges of gastrointestinal tumors in the Gulf and Levant countries
Rare Tumors GI Group, Fadi Farhat, Abdulaziz Al Farsi, Ahmed Mohieldin, Bassim Al Bahrani, Eman Sbaity, Hassan Jaffar, Joseph Kattan, Kakil Rasul, Khairallah Saad, Tarek Assi, Waleed El Morsi, Rafid A Abood
Fadi Farhat, Hammoud Hospital UMC, Saida PO Box 652, Lebanon
Abdulaziz Al Farsi, Bassim Al Bahrani, Medical Oncology Department, Royal Hospital, Muscat PO Box 1331, Oman
Ahmed Mohieldin, Medical Oncology Department, Kuwait Cancer Control Center, Kuwait PO Box 42262, Kuwait
Eman Sbaity, Division of General Surgery, American University of Beirut, Beirut 1107 2180, Lebanon
Hassan Jaffar, Oncology Department, Tawam Hospital, Al Ain PO Box 15258, United Arab Emirates
Joseph Kattan, Hemato-oncology Department, Hotel Dieu de France, Beirut, Lebanon
Kakil Rasul, Hemato-oncology Department, National Center for Cancer Care and Research, Doha, Qatar
Khairallah Saad, Pathology Department, Institute National de Pathologic, Beirut, Lebanon
Tarek Assi, Oncology Department, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon
Waleed El Morsi, Pfizer Oncology-Emerging Markets, Dubai Media City, Dubai, United Arab Emirates
Rafid A Abood, Oncology Department, Basra College of Medicine, Basra, Iraq
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
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.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fadi Farhat, MD, Chief Physician, Professor, Head, Chairman, Rare Tumors GI Group, Hemato-oncology Department, Hammoud Hospital UMC, Dr. Ghassan Hammoud Street, PO Box 652, Saida, Lebanon. drfadifarhat@hammoudhospital.com
Received: September 24, 2019
Peer-review started: September 24, 2019
First decision: November 4, 2019
Revised: December 13, 2019
Accepted: January 1, 2020
Article in press: January 1, 2020
Published online: February 6, 2020
Processing time: 134 Days and 14 Hours
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: Gastrointestinal stromal tumors; Diagnosis; Disease management; Treatment; Challenges; Middle East

Core tip: Challenges faced by Middle Eastern clinicians in the management of gastrointestinal stromal tumor patients are numerous. Firstly, a lack of experience and equipment at non-cancer centres, lack of histopathologists with sarcoma expertise and limited access to radiological assessments present a hurdle to diagnosis. Secondly, management of patients by surgeons and gastroenterologists with limited oncology expertise, lack of access by healthcare authorities to guidelines, inadequate training of onco-surgeons and lack of radiological assessment to inform treatment can result in poor patient management. Furthermore, patient access to novel tyrosine kinase inhibitors or trials and a lack of patient understanding of treatment compliance also present challenges.