Adjuvant Imatinib for High-Risk GI Stromal Tumor: Analysis of a Randomized Trial

Joensuu, Heikki; Eriksson, Mikael; Hall, Kirsten Sundby; Reichardt, Annette; Hartmann, J. T.; Pink, Daniel; Ramadori, Giuliano; Hohenberger, Peter; Al‐Batran, Salah‐Eddin; Schlemmer, M.; Bauer, Sebastian; Wardelmann, Eva; Nilsson, Bengt; Sihto, Harri; Bono, Petri; Kallio, Raija; Junnila, Jouni; Alvegård, Thor; Reichardt, Peter

doi:10.1200/jco.2015.62.9170

Cited by 192 publications

(147 citation statements)

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“…After resection of primary GIST at moderate to high-risk of recurrence, adjuvant imatinib has become the standard of care, based on large phase III randomized trials showing improved oncologic outcome 9,10 . Neoadjuvant imatinib is sometimes employed in an attempt to downsize locally advanced GISTs and may allow R0 resection in up to 83% of patients.…”

Section: Introductionmentioning

confidence: 99%

Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome

et al. 2017

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INTRODUCTION About 5% of GISTs originate in the rectum and historically radical resection was commonly performed. Little is known about the outcome of rectal GIST in the era of imatinib. METHODS Using a prospectively maintained database, we retrospectively analyzed 47 localized, primary rectal GISTs treated at our center from 1982 to 2016, stratified by when imatinib became available in 2000. Overall, disease-specific, and recurrence-free survival (OS, DSS, and RFS) were analyzed by the Kaplan-Meier method. RESULTS Rectal GISTs represented 7.1% of 663 primary GISTs. There were 17 patients in the pre-imatinib era and 30 in the imatinib era. The 2 groups had similar follow-up, age, gender, Miettinen risk, and distance to the anal verge. In the imatinib era, tumors were smaller at diagnosis (median 4.0 vs. 5.0 cm, p=0.029) and 24 of 30 patients received perioperative imatinib. In high-risk patients, organ-preservation and negative margins were more common in the 13 patients treated with neoadjuvant imatinib compared to the 21 treated directly with surgery. High-risk patients who received perioperative imatinib (n=15) had greater (or nearly significantly greater) 5yr OS, DSS, local RFS, and distant RFS than those (n=19) who did not (91, 100, 100, and 71% compared to 47, 65, 74, and 41%, p=0.049, 0.052, 0.077, 0.051, respectively). In the imatinib era, no patient has had a local recurrence or death due to GIST. CONCLUSIONS The use of imatinib is associated with organ-preservation and improved oncologic outcome in rectal GIST.

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Section: Introductionmentioning

confidence: 99%

Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome

et al. 2017

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“…Imatinib mesylate was given to these 5 patients after recurrence. It was reported that adjuvant imatinib mesylate after resection significantly improved RFS and OS [25,26]. Our 2 patients underwent adjuvant imatinib mesylate after primary complete resection and had no recurrence during the follow-up period.…”

Section: Discussionmentioning

confidence: 97%

Endoscopic Characteristics, Risk Grade, and Prognostic Prediction in Gastrointestinal Stromal Tumors of the Small Bowel

et al. 2017

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Background/Aims: Balloon-assisted endoscopy allows us to diagnose gastrointestinal (GI) stromal tumors (GISTs) in the small bowel including endoscopic ultrasonography and taking biopsy. The aim of this study was to retrospectively clarify clinical and endoscopic characteristics of small bowel GISTs using double-balloon endoscopy (DBE). Methods: We reviewed 25 patients who underwent DBE and were diagnosed with GISTs. The risk of GISTs was stratified using the National Institute of Health (NIH) consensus criteria. We evaluated the available DBE route, the diagnostic yield of biopsy examination, and the relationship between endoscopic characteristics and recurrence-free survival (RFS). Results: Of all 25 patients, 23 had any endoscopic findings related to GIST. They were detected using the antegrade approach in 91.3%. GISTs were classified into high risk (n = 7), intermediate risk (n = 4), low risk (n = 10), and very low risk (n = 4) based on surgical specimens. The diagnostic result of biopsy was 46.7% (7/15), but it was difficult to predict the NIH risk group. Endoscopic characteristics were not associated with RFS. The NIH risk group was significantly associated with RFS. Conclusions: Antegrade DBE was preferable for exploring small bowel GIST, but the diagnostic ability of biopsy examination was limited.

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“…Das progressionsfreie Überleben in den einzelnen Studien ist sehr lang. Allerdings ist die Interpretation dieser Ergebnisse im Vergleich zu Serien mit primär operierten Patienten schwierig, da die Indikation zur zusätzli-chen postoperativen Imatinib-Therapie, die einen erheblichen Einfluss auf das Auftreten eines Rezidives hat [16,17], in den einzelnen Studien heterogen gestellt wurde.…”

Section: Nicht Metastasierte Gist -Primäre Resektion Vs Neoadjuvanteunclassified

Fortgeschrittene gastrointestinale Stromatumoren

Ronellenfitsch

Henzler

Menge

et al. 2016

Chirurg

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Adjuvant Imatinib for High-Risk GI Stromal Tumor: Analysis of a Randomized Trial

Abstract: Three years of adjuvant imatinib therapy results in longer survival than 1 year of imatinib. High 5-year survival rates are achievable in patient populations with high-risk GIST.

Cited by 192 publications

References 28 publications

Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome

Rectal Gastrointestinal Stromal Tumor (GIST) in the Era of Imatinib: Organ Preservation and Improved Oncologic Outcome

Endoscopic Characteristics, Risk Grade, and Prognostic Prediction in Gastrointestinal Stromal Tumors of the Small Bowel

Fortgeschrittene gastrointestinale Stromatumoren

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