A Case of Disseminated Intra-abdominal Gastrointestinal Stromal Tumor Managed with Low Dose Imatinib

Jang, Bo Hyun; Kim, Byung‐Wook; Lim, Keun Joon; Kim, Boo Gyoung; Park, Sung Min; Kim, Joon Sung; Ji, Jeong‐Seon; Choi, Hwang

doi:10.4166/kjg.2015.65.6.366

Cited by 8 publications

(6 citation statements)

References 10 publications

(8 reference statements)

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“…Topical and systemic corticosteroids have been found to be effective against imatinib-induced skin reactions [10] . Low-dose imatinib was sufficiently effective in our two reported cases as well as in past case reports [9] . However, it is still unknown whether reduced-dose imatinib is also effective for GISTs.…”

Section: Discussionsupporting

confidence: 77%

“…Thus, we reduced the dose of imatinib to control adverse events. A previous case report showed that reducing imatinib to 200 mg/day allowed patients with metastatic GIST suffering from severe adverse events, such as skin rash, tremor, and alopecia, to continue treatment with tolerable side effects (rash) [9] . In case 2, we combined systemic steroids for skin rash.…”

Section: Discussionmentioning

confidence: 99%

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Benefit of Continuation of Low-Dose Imatinib for Gastrointestinal Stromal Tumors despite Adverse Events with Regular-Dose Imatinib

Katsumata

Monobe

Katata

et al. 2023

Case Rep Gastroenterol

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Tyrosine kinase inhibitors (TKIs) such as imatinib improve the prognosis of patients with gastrointestinal stromal tumors (GISTs). However, treatment options for GISTs are still limited, and the continuation of TKIs is difficult due to adverse events in some cases. The effectiveness of low-dose imatinib is unclear. We report 2 cases to show effectiveness of low-dose imatinib in patients with adverse events. The first case is a male in his early 60s with a history of intestinal GIST resection who was diagnosed with recurrent GIST with peritoneal dissemination. He was started on low-dose imatinib (300 mg) because of a history of subconjunctival hemorrhage after receiving postoperative imatinib. Follow-up contrast-enhanced ultrasonography revealed that the tumors had shrunk in size and number after 2 months of treatment with 300-mg imatinib. He continued this treatment and showed partial response for 8 months. The second case is a female in her late 70s with rectal GIST who was treated with imatinib 400 mg. Due to a severe skin lesion, she changed her treatment to sunitinib 2 months after initiation. However, new metastasis in the liver was confirmed after 4 months of administration of sunitinib. She underwent surgical esection of the rectal tumor to reduce the volume. After the surgery, low-dose imatinib (300 mg) with oral steroids was adopted. Follow-up confirmed the absence of recurrence at the rectum and no increase in hepatic tumor size for 18 months. Aggressive treatment with low-dose imatinib instead of discontinuation or alteration of treatment may benefit patients with unresectable and postoperative GISTs with sensible mutation to imatinib.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Benefit of Continuation of Low-Dose Imatinib for Gastrointestinal Stromal Tumors despite Adverse Events with Regular-Dose Imatinib

Katsumata

Monobe

Katata

et al. 2023

Case Rep Gastroenterol

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“…13 Thus, in Asia, lowdose continuous adjuvant imatinib should be recommended for intolerable patients, as supported by relevant research. 32,33 As the recommended dose cannot be tolerated for some Asian patients, finding the optimal treatment duration could be more important than increasing the dose of imatinib for such patients. Therefore, seeking the appropriate adjuvant duration for imatinib might be the key point of studies at this stage.…”

Section: Discussionmentioning

confidence: 99%

“…Among 855 patients, 17.7% (n = 151) of the patients discontinued adjuvant imatinib for intolerance or severe side effects within 1 year, which was more than that in the RCT including Westerners only 13 . Thus, in Asia, low‐dose continuous adjuvant imatinib should be recommended for intolerable patients, as supported by relevant research 32,33 . As the recommended dose cannot be tolerated for some Asian patients, finding the optimal treatment duration could be more important than increasing the dose of imatinib for such patients.…”

Section: Discussionmentioning

confidence: 99%

Development and external validation of a nomogram for individualized adjuvant imatinib duration for high‐risk gastrointestinal stromal tumors: A multicenter retrospective cohort study

Liu

Gong

et al. 2022

Cancer Medicine

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Introduction The main emphasis of the research about adjuvant imatinib for high‐risk gastrointestinal stromal tumors (GISTs) is prolonging the treatment duration and ignores the heterogeneous that 10‐year recurrence rates ranged from about 20%–100%. Thus, this study evaluated the effect of different durations of adjuvant imatinib on outcomes in high‐risk GISTs to explore the feasibility of individual treatment. Methods We analyzed 855 high‐risk GIST patients from three centers who underwent macroscopically complete resection between December 2007 and September 2020. The patients were divided into training (n =564) and two validation cohorts (n = 238 and53) based on their source. Recurrence‐free survival (RFS) was the primary point. Cox multivariate analysis was used to develop the nomogram. C‐index, time‐dependent area under the curves, and calibration plots were used to assess the performance of the nomogram. Results Univariate analysis showed that longer adjuvant imatinib was significantly associated with better 5‐year RFS (p < 0.0001). Further investigation identified that the same high‐risk patients with lower tumor‐associated recurrence risk benefitted little from prolonged treatment and that the recommended adjuvant imatinib duration was insufficient for those with higher recurrence risk. A nomogram for predicting 2‐, 3‐, and 5‐year RFS based on different treatment durations and four major risk factors, namely, tumor site, size, mitotic count, and rupture status, was built and validated, with a C‐index of 0.82, 0.74, and 0.70 in training and two external validation cohorts, respectively. An online dynamic nomogram was further developed for clinical applications (https://ruolinliu666.shinyapps.io/GIST/), offering predictive recurrence rates based on different treatment durations and tumor features. Conclusions We developed a nomogram to predict the recurrence risk for high‐risk patients according to tumor features and treatment durations of imatinib to help physicians on decision‐making for individualized treatment duration.

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“…The gradual decrease reduced the size of the metastatic GIST and notably mitigated the adverse events. [15] Meanwhile, Faber et al [16] reported that lower dose IM can be effective in patients with chronic myeloid leukemia. Considering the high inter-individual pharmacokinetic variability of IM, these results suggest that a more individualized treatment is more appropriate than methods with fixed dosage of IM.…”

Section: Discussionmentioning

confidence: 99%

A lower dosage of imatinib in patients with gastrointestinal stromal tumors with toxicity of the treatment

Yin

Xiang²,

Tang³

et al. 2016

Medicine

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This study investigated the efficiency and safety of imatinib in the lower dose (300 mg/d) in patients with gastrointestinal stromal tumor (GIST) who cannot tolerate imatinib in the standard dose (400 mg/d).Steady-state imatinib trough concentration (Cmin) values in 18 patients with GIST who were taking 300 mg/d or 400 mg/d imatinib were measured. The clinical features, toxicity data, and follow-up data were collected.Around 18 patients with GIST were investigated in which 9 patients received 300 mg/d imatinib. The mean imatinib Cmin value of the 18 patients was 1841 ng/mL (1018–3897 ng/mL). The difference between the patients treated with 400 mg/d (n=9) and those treated with 300 mg/d (n = 9), which have imatinib Cmin values of 2122±1003 ng/mL and 1559±478 ng/mL, respectively, was not significant (P = 0.148). In total, 12 of the 18 patients had complete resection of the primary tumor, 8 of whom received postoperative imatinib 300 mg/d. After the average follow-up of 15.4 months, no recurrence was documented. Of the 6 patients with unresected GIST, 1 received imatinib 300 mg/d for 13 months. The tumor size of this patient continued to decrease. In contrast to patients treated with imatinib 400 mg/d, patients treated with imatinib 300 mg/d notably exhibited lesser drug-related side effects.Patients with GIST who exhibited intolerance to the standard dose of imatinib (400 mg/d), a lower dose of 300 mg/d could provide not only sufficient plasma Cmin and good disease control but also the alleviation of the side effects.

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A Case of Disseminated Intra-abdominal Gastrointestinal Stromal Tumor Managed with Low Dose Imatinib

Cited by 8 publications

References 10 publications

Benefit of Continuation of Low-Dose Imatinib for Gastrointestinal Stromal Tumors despite Adverse Events with Regular-Dose Imatinib

Benefit of Continuation of Low-Dose Imatinib for Gastrointestinal Stromal Tumors despite Adverse Events with Regular-Dose Imatinib

Development and external validation of a nomogram for individualized adjuvant imatinib duration for high‐risk gastrointestinal stromal tumors: A multicenter retrospective cohort study

A lower dosage of imatinib in patients with gastrointestinal stromal tumors with toxicity of the treatment

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