{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:45:14Z","timestamp":1789753514192,"version":"4.0.1"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100030760","name":"Bayer in The US","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100030760","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gastrointestinal stromal tumors (GIST) are the most common gastrointestinal soft tissue sarcoma. Tyrosine kinase inhibitors are guideline-recommended therapy; however, resistance often occurs, requiring subsequent therapy. Regorafenib is a multikinase inhibitor approved for third-line therapy. Real-world data surrounding regorafenib\u2019s use and place in therapy are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To understand real-world regorafenib utilization and patient characteristics among US patients with advanced GIST.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort claims analysis used data from Merative\u2122 MarketScan\n                      <jats:sup>\u00ae<\/jats:sup>\n                      research databases and included patients with \u22651 pharmacy claim for regorafenib during the identification period (10\/2015\u20135\/2023) and \u22651 GIST diagnoses any time prior to\/on index date (first regorafenib prescription claim). Primary outcomes included duration of therapy (DOT) and time to next therapy (TTNT). Outcomes were stratified based on prior GIST treatment during the baseline period (BL) and initial regorafenib dose (i.e., low dose [LD] or regorafenib standard dose [RSD]) as of the index date.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nearly half (45.2%) of patients received imatinib and sunitinib prior to regorafenib initiation, and 73.5% received RSD. Patients who received prior imatinib or sunitinib alone before regorafenib had a numerically longer median DOT with regorafenib than those who received both in the BL before regorafenib (142.5 days [IQR: 87\u2013257.5] vs 95 days [IQR: 53\u2013192]). Patients receiving LD and RSD demonstrated similar median DOT (103.0 days [IQR: 41.5, 210.5] vs 94.5 days [IQR: (35.0, 171.0]) and TTNT (143 days [IQR: 70\u2013293] vs 141 days [IQR: 77\u2013191]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients on LD and RSD had similar DOT and TTNT. Acknowledging the limitations from this real-world data, patients with prior imatinib or sunitinib alone appeared to have longer DOT on regorafenib than those who received both. Further research is warranted to explore the clinical benefits of these differences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0353357","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:34:32Z","timestamp":1785519272000},"page":"e0353357","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Real-world regorafenib use among patients with advanced gastrointestinal stromal tumor in the United States"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9698-9201","authenticated-orcid":true,"given":"Ryan A.","family":"Denu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreevalsa","family":"Appukkuttan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Hocum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nick","family":"Liao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arvind","family":"Katta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihaeng","family":"Heo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bridgette","family":"Schroader","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risho","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetlana","family":"Babajanyan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeta","family":"Somaiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"issue":"15","key":"pone.0353357.ref001","doi-asserted-by":"crossref","first-page":"3689","DOI":"10.3390\/cancers14153689","article-title":"Gastrointestinal stromal tumors (GIST): a population-based study using the SEER database, including management and recent advances in targeted therapy","volume":"14","author":"J Khan","year":"2022","journal-title":"Cancers (Basel)"},{"issue":"13","key":"pone.0353357.ref002","doi-asserted-by":"crossref","first-page":"2187","DOI":"10.1002\/cncr.33630","article-title":"An updated review of the treatment landscape for advanced gastrointestinal stromal tumors","volume":"127","author":"SR Patel","year":"2021","journal-title":"Cancer"},{"issue":"11","key":"pone.0353357.ref003","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1007\/s11604-022-01305-x","article-title":"Gastrointestinal stromal tumors: a comprehensive radiological review","volume":"40","author":"A Inoue","year":"2022","journal-title":"Jpn J Radiol"},{"key":"pone.0353357.ref004","unstructured":"American Cancer Society. Key statistics for gastrointestinal stromal tumors; 2023. Available from: https:\/\/www.cancer.org\/cancer\/types\/gastrointestinal-stromal-tumor\/about\/key-statistics.html"},{"key":"pone.0353357.ref005","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.canep.2015.10.031","article-title":"Global epidemiology of gastrointestinal stromal tumours (GIST): a systematic review of population-based cohort studies","volume":"40","author":"K S\u00f8reide","year":"2016","journal-title":"Cancer Epidemiol"},{"issue":"1","key":"pone.0353357.ref006","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1097\/00000658-200001000-00008","article-title":"Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival","volume":"231","author":"RP DeMatteo","year":"2000","journal-title":"Ann Surg"},{"issue":"3","key":"pone.0353357.ref007","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S1470-2045(11)70299-6","article-title":"Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts","volume":"13","author":"H Joensuu","year":"2012","journal-title":"Lancet Oncol"},{"key":"pone.0353357.ref008","doi-asserted-by":"crossref","first-page":"5123","DOI":"10.2147\/OTT.S180763","article-title":"Targeted therapy and personalized medicine in gastrointestinal stromal tumors: drug resistance, mechanisms, and treatment strategies","volume":"12","author":"GZ Li","year":"2019","journal-title":"Onco Targets Ther"},{"issue":"1","key":"pone.0353357.ref009","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.annonc.2021.09.005","article-title":"Gastrointestinal stromal tumours: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"33","author":"PG Casali","year":"2022","journal-title":"Ann Oncol"},{"key":"pone.0353357.ref010","doi-asserted-by":"crossref","first-page":"672500","DOI":"10.3389\/fonc.2021.672500","article-title":"Early and next-generation KIT\/PDGFRA kinase inhibitors and the future of treatment for advanced gastrointestinal stromal tumor","volume":"11","author":"S Bauer","year":"2021","journal-title":"Front Oncol"},{"issue":"11","key":"pone.0353357.ref011","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.6004\/jnccn.2022.0058","article-title":"NCCN Guidelines\u00ae insights: gastrointestinal stromal tumors, version 2.2022","volume":"20","author":"M von Mehren","year":"2022","journal-title":"J Natl Compr Canc Netw"},{"issue":"1","key":"pone.0353357.ref012","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1186\/s13045-020-00977-0","article-title":"Tyrosine kinase inhibitors for solid tumors in the past 20 years (2001\u20132020)","volume":"13","author":"L Huang","year":"2020","journal-title":"J Hematol Oncol"},{"issue":"15","key":"pone.0353357.ref013","doi-asserted-by":"crossref","first-page":"3879","DOI":"10.3390\/cancers15153879","article-title":"KIT and PDGFRA variants and the survival of patients with gastrointestinal stromal tumor treated with adjuvant imatinib","volume":"15","author":"H Joensuu","year":"2023","journal-title":"Cancers (Basel)"},{"issue":"4","key":"pone.0353357.ref014","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1111\/j.1349-7006.2008.00727.x","article-title":"Secondary mutations in the kinase domain of the KIT gene are predominant in imatinib-resistant gastrointestinal stromal tumor","volume":"99","author":"T Nishida","year":"2008","journal-title":"Cancer Sci"},{"issue":"5","key":"pone.0353357.ref015","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1177\/1758834012450935","article-title":"Current and emerging strategies for the management of imatinib-refractory advanced gastrointestinal stromal tumors","volume":"4","author":"D Kee","year":"2012","journal-title":"Ther Adv Med Oncol"},{"issue":"11","key":"pone.0353357.ref016","doi-asserted-by":"crossref","first-page":"4182","DOI":"10.1158\/1078-0432.CCR-04-2245","article-title":"Acquired resistance to imatinib in gastrointestinal stromal tumor occurs through secondary gene mutation","volume":"11","author":"CR Antonescu","year":"2005","journal-title":"Clin Cancer Res"},{"issue":"2","key":"pone.0353357.ref017","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1053\/j.gastro.2004.11.020","article-title":"Mechanisms of resistance to imatinib mesylate in gastrointestinal stromal tumors and activity of the PKC412 inhibitor against imatinib-resistant mutants","volume":"128","author":"M Debiec-Rychter","year":"2005","journal-title":"Gastroenterology"},{"issue":"3","key":"pone.0353357.ref018","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1038\/s41419-024-06571-3","article-title":"Deciphering the tumor immune microenvironment of imatinib-resistance in advanced gastrointestinal stromal tumors at single-cell resolution","volume":"15","author":"X Liu","year":"2024","journal-title":"Cell Death Dis"},{"key":"pone.0353357.ref019","volume-title":"Stivarga","year":"2020"},{"issue":"5","key":"pone.0353357.ref020","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1177\/1758834014544892","article-title":"Regorafenib in gastrointestinal stromal tumors: clinical evidence and place in therapy","volume":"6","author":"D Ferraro","year":"2014","journal-title":"Ther Adv Med Oncol"},{"key":"pone.0353357.ref021","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13569-019-0114-5","article-title":"Survival in advanced GIST has improved over time and correlates with increased access to post-imatinib tyrosine kinase inhibitors: results from Life Raft Group Registry","volume":"9","author":"JW Call","year":"2019","journal-title":"Clin Sarcoma Res"},{"issue":"1","key":"pone.0353357.ref022","doi-asserted-by":"crossref","first-page":"9519","DOI":"10.1038\/s41598-017-09132-1","article-title":"Treatment patterns, efficacy and toxicity of regorafenib in gastrointestinal stromal tumour patients","volume":"7","author":"G Schvartsman","year":"2017","journal-title":"Sci Rep"},{"key":"pone.0353357.ref023","unstructured":"Centers for Medicare & Medicaid Services. ICD-10 codes. Centers for Medicare & Medicaid Services Web Site. [cited 2024 Jul 1]. Available from: https:\/\/www.cms.gov\/medicare\/coding-billing\/icd-10-codes\/2024-icd-10-cm"},{"issue":"6","key":"pone.0353357.ref024","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/aje\/kwq433","article-title":"Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries","volume":"173","author":"H Quan","year":"2011","journal-title":"Am J Epidemiol"},{"issue":"11","key":"pone.0353357.ref025","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1097\/01.mlr.0000182534.19832.83","article-title":"Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data","volume":"43","author":"H Quan","year":"2005","journal-title":"Med Care"},{"issue":"6","key":"pone.0353357.ref026","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1038\/s41416-019-0388-7","article-title":"Secondary KIT mutations: the GIST of drug resistance and sensitivity","volume":"120","author":"A Napolitano","year":"2019","journal-title":"Br J Cancer"},{"key":"pone.0353357.ref027","unstructured":"Sagonowsky E. The top 10 drugs losing U.S. exclusivity in 2021 Fierce Pharma: Fierce Pharma Biopharma News & Insights; 2021. Available from: https:\/\/www.fiercepharma.com\/special-report\/top-10-drugs-losing-u-s-exclusivity-2021"},{"issue":"4","key":"pone.0353357.ref028","article-title":"FDA approves Stivarga for GIST","volume":"3","year":"2013","journal-title":"Cancer Discov"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353357","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:34:37Z","timestamp":1785519277000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353357"}},"subtitle":[],"editor":[{"given":"Anette","family":"Duensing","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,31]]},"references-count":28,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0353357","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,31]]}}}