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Role of imatinib in the management of early, operable, and advanced GI stromal tumors (GISTs)

By John T Vetto


Gastrointestinal stromal tumors (GISTs), the most common sarcoma of the GI tract, have unique kinase mutations that serve as targets for medical therapy. This article reviews the data supporting the use of the tyrosine kinase inhibitor (TKI) imatinib in GIST patients, and how this treatment should be combined with surgical resection (when possible) to optimize patient outcomes. Although surgical resection remains the mainstay of treatment for these tumors, patients with resected GISTs have high relapse rates that can be reduced by 1 year of adjuvant imatinib. Data also support the use of imatinib for patients with recurrent or unresectable GIST. In these patients the drug should be continued until progression, intolerance, or the patients are rendered resectable. Patients with advanced GIST who are successfully resected after imatinib treatment should be placed back on imatinib postoperatively. Patients who develop generalized progression (progression at 2 or more sites) on imatinib should move to other treatments, such as newer TKIs or other targeted approaches currently under study. Genotyping of the tumor should be considered in all pediatric GISTs and high risk adult GISTs, especially if there is progression on imatinib. Quality of life and the cost/benefit of new therapies are important issues for further study in patients with GIST

Topics: Review
Publisher: Dove Medical Press
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Provided by: PubMed Central

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  4. Biology of gastrointestinal stromal tumors.
  5. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Human Pathol.
  6. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors.
  7. (2008). Efficacy of adjuvant imatinib mesylate following complete resection of localized, primary gastrointestinal stromal tumor (GIST)at high risk of recurrence:
  8. (2007). Gastrointestinal stromal tumors: diagnostic challenges and practical approach to differential diagnosis. Adv Anat Pathol.
  9. Gastrointestinal stromal tumors: past, present, and future.
  10. Gastrointestinal stromal tumour.
  11. (2006). High incidence of microscopic gastrointestinal stromal tumors in the stomach. Human Pathol.
  12. How I do it: management of gastrointestinal stromal tumors.
  13. (2006). Impact of surgery on advanced gastrointestinal stromal tumors (GIST) in the imatinib mesylate era. Ann Surg Oncol.
  14. Laparoscopic wedge resection for gastric GIST: long-term follow-up results.
  15. Lessons learned from the development of an Abl tyrosine kinase inhibitor for chronic myelogenous leukemia.
  16. Limited gastric resection. Surg Clin NA.
  17. (2006). Long-term outcomes of laparoscopic resection of gastrointestinal stromal tumors. Ann Surg.
  18. Management of gastrointestinal stromal tumors. Surg Clin NA.
  19. Mechanisms of sunitinib malate resistance in gastrointestinal stromal tumors.
  20. Minute gastric schlerosing stromal tumors (GIST tumorlets) are common in adults and frequently show c-KIT mutations.
  21. (2008). Molecular targets in Gastrointestinal Stromal Tumors (GIST) therapy. Curr Cancer Drug Targets.
  22. NCCN Task Force report: management of patients with gastrointestinal stromal tumor (GIST)-update of the NCCN clinical practice guidelines.
  23. (2008). Novel approaches to imatinib-resistant GIST. Curr Oncol Rep.
  24. (2008). Phase II trial of neoadjuvant/ adjuvant imatinib mesylate (IM) for advanced primary and metastatic recurrent operable gastrointestinal stromal tumor (GIST): early results of RTOG 0132/ACRIN 6665. J Surg Oncol.
  25. Phase III dose-randomized study of imatinib mesylate (STI571) for GIST: Intergroup S0033 early results.
  26. (2009). Practice Guidelines in Oncology: Soft Tissue Sarcoma, V.2.2007. Available at: guidelines.pdf (accessed
  27. Prognosis, imatinib dose, and benefit of sunitinib in GIST: knowing the genotype.
  28. Prospective multicentric randomized phase III study of imatinib in patients with advanced gastrointestinal stromal tumors comparing interruption versus continuation of treatment beyond 1 year: the French Sarcoma group.
  29. (2007). Results of tyrosine kinase inhibitor therapy followed by surgical resection in metastatic gastrointestinal stromal tumor. Ann Surg.
  30. (2007). Should soft tissue sarcomas be treated at high volume centers? An analysis of 4205 patients. Ann Surg.
  31. (2005). State-of-the art therapy for gastrointestinal stromal tumors. Cancer Invest.
  32. (2007). Surgery of residual disease using molecular-targeted therapy with imatinib mesylate in advanced/ metastatic GIST. Ann Surg.
  33. (2007). Surgical considerations for the management and resection of esophageal gastrointestinal tumors. Ann Thor Surg.
  34. Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors.
  35. (2007). Surgical resection of gastrointestinal tumors after treatment with imatinib. Ann Surg Oncol.
  36. Surgical strategy for gastrointestinal stromal tumors: laparoscopic vs. open resection. Surg Endosc.
  37. Surgical treatment for gastric GIST with special reference to liver metastases.
  38. Surgical treatment of patients with initially inoperable and/or metastatic gastrointestinal stromal tumors (GIST) during therapy with imatinib mesylate.
  39. (2007). The epidemiologic, health-related quality of life, and economic burden of gastrointestinal stromal tumours. J Clin Pharm Ther.
  40. (2008). Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor
  41. We should desist in using RECIST, at least in GIST.