Outcomes of patients with gastrointestinal stromal tumors treated with imatinib and sunitinib in Nepal: A 20-year analysis.

e23520 Background: Gastrointestinal stromal tumors (GIST) are rare mesenchymal tumors of the gastrointestinal tract. Targeted therapies, including imatinib and sunitinib, have significantly improved outcomes for patients with GIST. However, real -world data on survival in low and middle-income countries (LMICs) remain scarce. Since 2004, The Max Foundation has provided access to treatment for GIST patients in many countries, including Nepal. This Abstract evaluates overall survival (OS) among patients in Nepal treated through this program. Methods: A retrospective cohort analysis was conducted using data from patients with KIT-positive GIST from Nepal enrolled in The Max foundation's treatment access program between 2004 and 2024. Patients were stratified into metastatic/unresectable and adjuvant treatment groups. The Kaplan-Meier product limit method was used to estimate OS. Associations between survival outcomes and covariates such as age, sex, treatment type, and disease setting will be examined using cox regression models. Results: A total of 721 patients with GIST were included in the analysis (388 male [53.8%]; median age at diagnosis 55 years [ range,8-87]), with similar demographic summaries across both groups. Among patients with metastatic/unresectable GIST who received only imatinib or both imatinib and second-line sunitinib (n=270), the median OS was 7.0 years (95% CI: 6.2-8.7), and the 5 year and 10 year survival rates were 65.6% (95% CI: 59.5%-72.4%) and 35.4% (95% CI: 28.4%-44.2%), respectively. Among patients who received adjuvant treatment with imatinib (n=451), the median OS was 11.1 years. (95% CI: 10.0-not estimable), and the 5-year and 10-year survival rates were 83.1% (95% CI: 78.6%-87.8%) and 58.1% (95% CI: 48.6%-69.5%) respectively. Conclusions: These results highlight the meaningful survival benefits of targeted therapies for GIST in a LMIC setting, with outcomes comparable to those reported in clinical trials from high -income countries. The findings highlight the importance of sustained access to treatment through innovative humanitarian programs that effectively address key barriers in LMICs, including treatment access, diagnostic limitation and supply chain challenges.