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Clinical Study

Unveiling the impact of adherence: imatinib plasma levels and survival in postoperative gastrointestinal stromal tumor (GIST) patients

British Journal of Cancer volume 133, pages 1307–1316 (2025)Cite this article

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Abstract

Background

Adherence to imatinib may be even more limited in the adjuvant setting, as patients receiving adjuvant imatinib often do not experience disease symptoms after tumor removal. This real-world study aimed to gain insight into adherence to imatinib and the effect of adherence on treatment outcomes.

Methods

Postoperative GIST patients who visited the speciality clinic between January 2021 and September 2024 were included in the study.

Results

Out of 143 patients, 45 were non-adherent. The restricted mean survival time (RMST) at 3 years was measured for progression-free survival (PFS). Non-adherent patients had an RMST of 24.65 months, whereas adherent patients had an RMST of 32.66 months (P < 0.05). In addition, the plasma trough concentration of imatinib (Cmin) was lower in non-adherent patients than in adherent patients (737.68 vs. 1404.45 ng/mL, P < 0.05). Using therapeutic drug monitoring (TDM) as an objective measurement to assess adherence, Cmin of 1211.50 ng/mL could be the optimal cutoff value to predict the risk of non-adherence.

Conclusions

Poor adherence to imatinib was a notable problem in postoperative adjuvant treatment and appeared to be associated with shorter PFS. Monitoring trough levels gives physicians an objective measurement to assess individual adherence and can support treatment decisions.

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Fig. 1
Fig. 2: The 3- and 5-year difference in the RMST of PFS for non-adherent and adherent patients.
Fig. 3: The correlation heatmap between imatinib concentrations and adherence assessment scores.
Fig. 4: Comparison of ROC curves and respective AUC of two nested models for adjuvant imatinib treatment adherence.
Fig. 5: Correlation between PFS and the Cmin cutoff value for adherence.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank the dedicated staff at the Department of Pharmacy and Department of Gastrointestinal Surgery, the First Affiliated Hospital of Ningbo University for their valuable work.

Funding

This research was supported by the Clinical Research Program of Zhejiang Medical Doctors Association (No. YS2022-2-006) and the Program of Zhejiang Provincial Medical and Health Science and Technology Plan (No. 2020KY813).

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  1. These authors contributed equally: Tao Xu, Jianming Xie.

Authors and Affiliations

  1. Department of Pharmacy, the First Affiliated Hospital of Ningbo University, Zhejiang, China

    Tao Xu, Chenrui Jiang, Suyan Zhu & Hongbin Xu

  2. Department of Gastrointestinal Surgery, the First Affiliated Hospital of Ningbo University, Zhejiang, China

    Jianming Xie & Zhilong Yan

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  1. Tao Xu
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Contributions

Conceptualization: Hongbin Xu; Methodology: Tao Xu; Formal analysis and investigation: Chenrui Jiang, Suyan Zhu; Writing - original draft preparation: Tao Xu; Writing - review and editing: Tao Xu, Zhilong Yan; Funding acquisition: Tao Xu, Jianming Xie; Resources: Jianming Xie; Supervision: Hongbin Xu. All authors read and approved the final manuscript.

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Correspondence to Hongbin Xu.

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The authors declare no competing interests.

Ethics approval

This study was approved by the Institutional Ethics Committee of the First Affiliated Hospital of Ningbo University (NO.2023043A-03) and was performed in accordance with the Declaration of Helsinki. Informed consent was waived by our Institutional Review Board because of the retrospective nature of our study. Clinical trial registration: ChiCTR2300075731.

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Xu, T., Xie, J., Jiang, C. et al. Unveiling the impact of adherence: imatinib plasma levels and survival in postoperative gastrointestinal stromal tumor (GIST) patients. Br J Cancer 133, 1307–1316 (2025). https://doi.org/10.1038/s41416-025-03173-4

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