Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib – Analysis of prognostic factors (EORTC-STBSG collaborative study)

Bauer, Sebastian; Rutkowski, Piotr; Hohenberger, Peter; Miceli, Rosalba; Fumagalli, Elena; Siedlecki, Janusz A.; Nguyen, Buu Phuc; Kerst, Martijn; Fiore, Marco; Nyckowski, P; Hoiczyk, Mathias; Cats, Annemieke; Casali, Paolo G.; Treckmann, Juergen; Coevorden, Frits van; Gronchi, Alessandro

doi:10.1016/j.ejso.2013.12.020

Cited by 139 publications

(111 citation statements)

References 13 publications

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“…Therefore, imatinib should be the first treatment of choice in this population (Figure 1). Translational Gastroenterology and Hepatology, 2018 Cytoreductive surgery for metastatic GISTs responding to imatinib Many retrospective studies of the feasibility of cytoreductive surgery during therapy with TKIs in patients with recurrent or metastatic GIST were conducted in American, European, and Asian institutions (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). Table 1 summarizes the results of 11 principal retrospective studies on cytoreductive surgery for recurrent or metastatic GISTs treated with TKIs.…”

Section: Front-line Surgery Prior To Imatinib Therapymentioning

confidence: 99%

Surgery for metastatic gastrointestinal stromal tumor: to whom and how to?

Kikuchi¹,

Hiramatsu²,

Kamiya³

et al. 2018

Transl. Gastroenterol. Hepatol.

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Although imatinib is a standard treatment for metastatic or recurrent gastrointestinal stromal tumors (GISTs), acquired c-kit mutations reportedly cause secondary resistance to imatinib. Sunitinib is a tyrosine kinase inhibitor (TKI) that can be used as second-line therapy in imatinib-resistant or -intolerant GISTs. For sunitinib-resistant or -intolerant GISTs, regorafenib is a standard third-line treatment. Although TKI therapies have revolutionized the treatment of recurrent or metastatic GISTs, they cannot cure GISTs.Therefore, in the era of TKIs, role of cytoreductive surgery for recurrent or metastatic GISTs has been discussed. Retrospective studies of treatment strategies with front-line surgery prior to imatinib have shown that initial cytoreduction confers no benefit in cases of advanced or recurrent GIST, and administering imatinib is the principle treatment. Most retrospective studies report cytoreductive surgery to be feasible in patients with metastatic GIST whose disease is stable or responsive to imatinib. Cytoreductive surgery may be indicated in limited disease progression refractory to imatinib when complete resection is possible, but case selection is critical. Cytoreductive surgery for metastatic GIST treated with sunitinib seems less feasible because of high rates of incomplete resections and complications. The role of cytoreductive surgery for metastatic GISTs would be difficult to establish in a prospective study; individualized treatments need to be carefully designed based on c-kit and platelet-derived growth factor receptor alpha (PDGFRA) mutations and other factors.

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Section: Front-line Surgery Prior To Imatinib Therapymentioning

confidence: 99%

Surgery for metastatic gastrointestinal stromal tumor: to whom and how to?

Kikuchi¹,

Hiramatsu²,

Kamiya³

et al. 2018

Transl. Gastroenterol. Hepatol.

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“…Notably, acquired resistance to imatinib has been reported in almost half of patients after 18 months (6). A recent multicentric study demonstrated that patients who underwent surgery for metastatic GIST disease after prolonged preoperative administration of TKIs had worse outcomes than those who received short neoadjuvant TKI treatments (26). Although the authors remarked that such results could be explained by a selection bias of patients with less desirable responses, they reached the conclusion that surgical resection confers maximum benefit only when undertaken within a short "window of opportunity" (26).…”

Section: Discussionmentioning

confidence: 99%

Management of liver metastases from gastrointestinal stromal tumors: where do we stand?

Machairas

Prodromidou

Molmenti

et al. 2017

J. Gastrointest. Oncol.

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Abstract:The recommended management of liver metastases (LM) from gastrointestinal stromal tumors (GISTs) disease consists of perioperative administration of tyrosine kinase inhibitors (TKIs) and surgical resection. The aim of our study was to investigate the efficacy of this therapeutic approach. Studies reporting outcomes for patients underwent liver resection from metastatic gastrointestinal stromal tumor (GIST) were overviewed. Eleven studies were included, which enrolled 240 patients with liver metastasis from GISTs.A median overall survival (OS) interval of 41.8 months was calculated while a median disease free interval of 17.9 [17-43] months following resection was also measured. Recurrences were recorded in 63 patients. Prognostic factors identified by the studies included surgical resection, R0 resection, age <55 years, clinical response to TKIs, pre-and postoperative administration of TKIs. The included studies highlight the importance of complete resection and the timing of resection, as well underline the importance of pre-and post-operative administration of TKIs.

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“…As the present case included a giant tumor with peritoneal metastasis, tumor rupture or macroscopic residual tumor (R2 resection) was a possible risk. Thus, neoadjuvant imatinib was administered to decrease the tumor size in order to achieve complete resection (R0/R1) (20). After 26 months of imatinib treatment, the patient underwent laparoscopic appendectomy and gross complete resection of the peritoneal metastatic tumor, without tumor rupture.…”

Section: Discussionmentioning

confidence: 99%

Giant gastrointestinal stromal tumor of the vermiform appendix: A case report

Kaneko

Kawai

Murono

et al. 2017

Molecular and Clinical Oncology

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Abstract.Gastrointestinal stromal tumors (GISTs) of the vermiform appendix are rare, measuring <3 cm in 82.4% of the reported cases. Neoadjuvant therapy with the receptor tyrosine kinase inhibitor imatinib mesylate has the potential to improve resectability and organ preservation rates in locally advanced or metastatic/recurrent GISTs. We herein report the case of a 67-year-old male patient with an unusually large GIST (22 cm in diameter) of uncertain origin in the right lower abdominal quadrant, with a solitary peritoneal metastasis. Due to the size of this GIST and presence of metastatic disease, neoadjuvant therapy with imatinib (400 mg/day orally) was administered. Follow-up imaging studies revealed marked shrinkage of the primary and metastatic tumors. Subsequently, laparoscopic exploration revealed that the main tumor originated from the tip of the vermiform appendix, and that the peritoneal metastasis was located in the ascending mesocolon. The patient underwent laparoscopic appendectomy and excision of the peritoneal metastasis, without tumor rupture. Therefore, in appropriately selected patients, neoadjuvant imatinib for borderline resectable or oligometastatic GISTs may be a reasonable choice.

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Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib – Analysis of prognostic factors (EORTC-STBSG collaborative study)

Cited by 139 publications

References 13 publications

Surgery for metastatic gastrointestinal stromal tumor: to whom and how to?

Surgery for metastatic gastrointestinal stromal tumor: to whom and how to?

Management of liver metastases from gastrointestinal stromal tumors: where do we stand?

Giant gastrointestinal stromal tumor of the vermiform appendix: A case report

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