Role of Surgery in Patients with Recurrent, Metastatic, or Unresectable Locally Advanced Gastrointestinal Stromal Tumors Sensitive to Imatinib: A Retrospective Analysis of the Spanish Group for Research on Sarcoma (GEIS)

Abstract

Based in its benefit in OS, our study supports surgery of metastatic disease in GIST patients who respond to imatinib therapy.

Neoadjuvant Imatinib in Locally Advanced Gastrointestinal stromal Tumours, Will Kit Mutation Analysis Be a Pathfinder?

“…While this can be considered as part of biological selection in terms of response to IM, it also proves the truly non-metastatic, locally advanced nature of patients in our study. Despite the benefits of IM, the primary treatment of operable GIST remains surgery and this has been comprehensively proven in previous studies [5,11,[21][22][23][24][25][26], thereby making it incumbent on treating oncologists to not unduly delay surgery.…”

Is multivisceral resection in locally advanced gastrointestinal stromal tumours an acceptable strategy?

“…In the former, TKI therapy serves to downsize unresectable tumours with the eventual aim of removing residual disease following response to imatinib. Several retrospective series have alluded to the role of neoadjuvant therapy in improving progression free survival (PFS) and OS . However, in the recently reported RTOG0132/ACRIN6665 trial, the first prospective study assessing the role of preoperative TKI in advanced primary and recurrent operable GIST, failed to establish that neoadjuvant sequencing adds more benefit than adjuvant systemic therapy alone.…”

“…Although the use of TKIs represents a major advancement in the treatment of GISTs, surgical resection remains the only chance of cure. In studies evaluating the role of imatinib in advanced or metastatic GISTs, complete pathological response was rarely achieved . It is likely that TKIs control but fail to eradicate all tumour cells.…”

“…In the pre‐imatinib era, locally advanced GISTs were primarily resected, MVR was common, and majority were removed with clear margins . Given the tremendous success of imatinib in unresectable or metastatic GISTs with up to 80% of patients achieving partial response or stable disease, some authors proposed the use of neoadjuvant TKI to downsize locally advanced GISTs as a strategy to decrease the morbidity of MVR and reduce the risk of tumour rupture or positive margins . However, there are no randomized trials comparing the efficacy of neoadjuvant TKI therapy followed by surgery with upfront surgery for locally advanced GIST.…”

Identification of preoperative factors associated with outcomes following surgical management of intra‐abdominal recurrent or metastatic GIST following neoadjuvant tyrosine kinase inhibitor therapy

“…However, the benefit of surgical resection in these patients with intra‐abdominal metastatic/recurrent GIST following tyrosine kinase inhibitor (TKI) therapy remains unclear and randomized control trials to answer this question have been unsuccessful due to early closure for to poor accrual . Over the last 15 years, a number of retrospective studies have evaluated the role of surgery in the multidisciplinary management of patients with metastatic GIST and identified prognostic factors associated with survival . In these reports, patients with progressive disease on TKI therapy did poorly.…”