7 Implementation and audit
7.1 All clinicians who treat people with KIT (CD117)-positive unresectable and/or KIT (CD117)-positive metastatic GIST should review their current policies and practice to take account of the guidance set out in Section 1.
7.2 Local guidelines or care pathways for the care of patients with KIT (CD117)-positive unresectable and/or KIT (CD117)-positive metastatic GIST should incorporate the guidance.
7.3 To measure compliance locally with the guidance, the following criteria could be used. Further details on suggestions for audit are presented in Appendix C.
7.3.1 For a person with KIT (CD117)-positive unresectable and/or KIT (CD117)-positive metastatic GIST, imatinib treatment at 400 mg/day is provided as first-line management for up to 12 weeks.
7.3.2 Imatinib therapy at 400 mg/day is continued beyond the first 12 weeks only if a person's GIST responds to treatment within 12 weeks. (Response to treatment is defined in Section 1.5 and Appendix D.)
7.3.3 A person whose GIST has responded to imatinib therapy is assessed at intervals of approximately 12 weeks and imatinib therapy at 400 mg/day is continued until the GIST ceases to respond. (Response to treatment is defined in Section 1.5 and Appendix D.)
7.3.4 If progressive disease develops in a person whose GIST initially responded to imatinib therapy, the dose of imatinib is not increased.
7.3.5 A cancer specialist with experience in the management of people with metastatic and/or unresectable GISTs supervises the use of imatinib.