Title: Barriers to Mutational Testing in Patients with Gastrointestinal Stromal Tumors (GIST)
– A Survey of Life Raft Group Members
Version: 1 Date: 05 Jul 2022
Reviewer's report:
This is a very nicely written study driven by in independent patient advocacy group and
addressing a very important and relevant issue. Only a quarter of patients with GIST in the US
are offered molecular testing, whilst previous studies have shown that molecular testing results
in change in management in about 20% of GIST patients in total and in 50% of GISTs harbouring
a mutation other than a KIT exon 11 mutation.
The study is relevant for both patients and health care providers dealing with GISTs.
Minor comments:
- Line 50-52: Are there more recent numbers of molecular testing in the US within the context
of new FDA approved smart molecular compounds available for rarer molecular subtypes?
- 'Characteristics of patients'  sub-sections could be added under RESULTS section
- Line 77: 'somewhat skewed' Please provide less suggestive wording.
- Line 87-89: Could the authors please elaborate on the % and numbers of patients treated outside
the  US?
- Line 90-93: the authors could consider adding this part in the discussion section describing
the limitations of this study.
- Line 100-101: Could the authors please consider to explain the number of institutions
mentioned and the number of patients this compromises? Are there patients treated in more than
one institution?
- Line 107-108: 'however, there was considerable crossover',  please remain strictly descriptive.
- Line 108-112: in this section the authors do not provide any numbers or %. Please, could you
use numbers instead of suggestive wording such as 'many patients' and 'some cases'.
- Line 113: 'one of the major findings of this survey'. Please omit using suggestive language and
remain strictly descriptive in the part. The implications could be discussed in the 'Discussion'
section of your paper.
- Line 119-121: 'as more studies...earlier diagnosis date'. I would kindly like to suggest for the
authors to strictly describe the numbers and % and keep the interpretation and implications of
these results for the 'Discussion' section of the paper.
- Line 122: How many patients had no mutational testing? Could you please provide number as
well as %? Please use this throughout your paper and please remain consistent.
- Line 128: 'One of the most important findings...' Please see previous comment (8th comment)
- Line 135-136: 'one patient's treatment did not change' was added as part of the group of patients
who had a change in treatment. Could the authors please explain?
- Section 'Treatment Changes Based on Mutational Testing'. This is very interesting information
indeed. Could the authors please provide which changes were patient's decision and which
patients were led by the healthcare provider?
- In the discussion section you mention that over 20% of your respondents are from outside the
US. Could you please comment on the difference in healthcare structures and funding and how
this may effect the rate of molecular testing in your population versus the general US population?
- Figure 4: 'Stopped Treatment' and 'Switched Treatment' was one of the options provided in
patients who had molecular testing resulting in change of management. This was subsequently
provided as an answer in the 'Other' section by 2 and 6 patients respectively. 2 patients also
changed treatment from TKI to surgery and another 2 changed from surgery to TKI. Could the
authors consider adding a total of 10 patients to 'Switched Treatment' and 2 patients to 'Stopped
Treatment'?
Title: Barriers to Mutational Testing in Patients with Gastrointestinal Stromal Tumors (GIST)
– A Survey of Life Raft Group Members
Version: 1 Date: 05 Jul 2022
Reviewer's report:
This is a very nicely written study driven by in independent patient advocacy group and
addressing a very important and relevant issue. Only a quarter of patients with GIST in the US
are offered molecular testing, whilst previous studies have shown that molecular testing results
in change in management in about 20% of GIST patients in total and in 50% of GISTs harbouring
a mutation other than a KIT exon 11 mutation.
The study is relevant for both patients and health care providers dealing with GISTs.
Minor comments:
- Line 50-52: Are there more recent numbers of molecular testing in the US within the context
of new FDA approved smart molecular compounds available for rarer molecular subtypes?
- 'Characteristics of patients'  sub-sections could be added under RESULTS section
- Line 77: 'somewhat skewed' Please provide less suggestive wording.
- Line 87-89: Could the authors please elaborate on the % and numbers of patients treated outside
the  US?
- Line 90-93: the authors could consider adding this part in the discussion section describing
the limitations of this study.
- Line 100-101: Could the authors please consider to explain the number of institutions
mentioned and the number of patients this compromises? Are there patients treated in more than
one institution?
- Line 107-108: 'however, there was considerable crossover',  please remain strictly descriptive.
- Line 108-112: in this section the authors do not provide any numbers or %. Please, could you
use numbers instead of suggestive wording such as 'many patients' and 'some cases'.
- Line 113: 'one of the major findings of this survey'. Please omit using suggestive language and
remain strictly descriptive in the part. The implications could be discussed in the 'Discussion'
section of your paper.
- Line 119-121: 'as more studies...earlier diagnosis date'. I would kindly like to suggest for the
authors to strictly describe the numbers and % and keep the interpretation and implications of
these results for the 'Discussion' section of the paper.
- Line 122: How many patients had no mutational testing? Could you please provide number as
well as %? Please use this throughout your paper and please remain consistent.
- Line 128: 'One of the most important findings...' Please see previous comment (8th comment)
- Line 135-136: 'one patient's treatment did not change' was added as part of the group of patients
who had a change in treatment. Could the authors please explain?
- Section 'Treatment Changes Based on Mutational Testing'. This is very interesting information
indeed. Could the authors please provide which changes were patient's decision and which
patients were led by the healthcare provider?
- In the discussion section you mention that over 20% of your respondents are from outside the
US. Could you please comment on the difference in healthcare structures and funding and how
this may effect the rate of molecular testing in your population versus the general US population?
- Figure 4: 'Stopped Treatment' and 'Switched Treatment' was one of the options provided in
patients who had molecular testing resulting in change of management. This was subsequently
provided as an answer in the 'Other' section by 2 and 6 patients respectively. 2 patients also
changed treatment from TKI to surgery and another 2 changed from surgery to TKI. Could the
authors consider adding a total of 10 patients to 'Switched Treatment' and 2 patients to 'Stopped
Treatment'?
Please review this paper.
user
Title: Barriers to Mutational Testing in Patients with Gastrointestinal Stromal Tumors (GIST)
– A Survey of Life Raft Group Members
Version: 1 Date: 05 Jul 2022
Reviewer's report:
This is a very nicely written study driven by in independent patient advocacy group and
addressing a very important and relevant issue. Only a quarter of patients with GIST in the US
are offered molecular testing, whilst previous studies have shown that molecular testing results
in change in management in about 20% of GIST patients in total and in 50% of GISTs harbouring
a mutation other than a KIT exon 11 mutation.
The study is relevant for both patients and health care providers dealing with GISTs.
Minor comments:
- Line 50-52: Are there more recent numbers of molecular testing in the US within the context
of new FDA approved smart molecular compounds available for rarer molecular subtypes?
- 'Characteristics of patients'  sub-sections could be added under RESULTS section
- Line 77: 'somewhat skewed' Please provide less suggestive wording.
- Line 87-89: Could the authors please elaborate on the % and numbers of patients treated outside
the  US?
- Line 90-93: the authors could consider adding this part in the discussion section describing
the limitations of this study.
- Line 100-101: Could the authors please consider to explain the number of institutions
mentioned and the number of patients this compromises? Are there patients treated in more than
one institution?
- Line 107-108: 'however, there was considerable crossover',  please remain strictly descriptive.
- Line 108-112: in this section the authors do not provide any numbers or %. Please, could you
use numbers instead of suggestive wording such as 'many patients' and 'some cases'.
- Line 113: 'one of the major findings of this survey'. Please omit using suggestive language and
remain strictly descriptive in the part. The implications could be discussed in the 'Discussion'
section of your paper.
- Line 119-121: 'as more studies...earlier diagnosis date'. I would kindly like to suggest for the
authors to strictly describe the numbers and % and keep the interpretation and implications of
these results for the 'Discussion' section of the paper.
- Line 122: How many patients had no mutational testing? Could you please provide number as
well as %? Please use this throughout your paper and please remain consistent.
- Line 128: 'One of the most important findings...' Please see previous comment (8th comment)
- Line 135-136: 'one patient's treatment did not change' was added as part of the group of patients
who had a change in treatment. Could the authors please explain?
- Section 'Treatment Changes Based on Mutational Testing'. This is very interesting information
indeed. Could the authors please provide which changes were patient's decision and which
patients were led by the healthcare provider?
- In the discussion section you mention that over 20% of your respondents are from outside the
US. Could you please comment on the difference in healthcare structures and funding and how
this may effect the rate of molecular testing in your population versus the general US population?
- Figure 4: 'Stopped Treatment' and 'Switched Treatment' was one of the options provided in
patients who had molecular testing resulting in change of management. This was subsequently
provided as an answer in the 'Other' section by 2 and 6 patients respectively. 2 patients also
changed treatment from TKI to surgery and another 2 changed from surgery to TKI. Could the
authors consider adding a total of 10 patients to 'Switched Treatment' and 2 patients to 'Stopped
Treatment'?
assistant