Sunitinib Treatment for Multiple Brain Metastases from Jejunal Gastrointestinal Stromal Tumor: Case Report

Abstract

Gastrointestinal stromal tumors (GISTs) are rare malignant tumors and only a few reported cases of brain metastases can be found. Introduction of a new molecular targeted agent, imatinib mesylate in the last decade has dramatically changed the treatment strategy and prognosis. However, imatinib is usually ineffective for brain metastasis from GISTs. The authors present the case of multiple brain metastases from jejunal GIST. The brain metastasis in the right prefrontal gyrus was detected 20 months after resection of the primary lesion when left hemiparesis began although the patient was on imatinib. Then the patient began taking sunitinib instead of imatinib, and the lesion shrunk and the symptom improved. However, after the dose reduction due to side effects, a new brain metastasis was found and this time, stereotactic radiation was effectively done. Sunitinib is one of the promising receptor tyrosine kinase inhibitors used for metastatic renal cell carcinomas or imatinib-refractory GISTs. Sunitinib is thought to penetrate bloodbrain barrier, and recent reports indicate effectiveness to brain metastasis. To the authors' knowledge, this is the fi rst report of brain metastases from jejunal GIST responding to sunitinib therapy.

Cerebellar metastasis of gastrointestinal stromal tumor: A case report and review of the literature

“…GISTs are frequent neoplasms occurring generally on patients around 60 years old [ 7 ]. Intracranial metastases of these gastro-intestinal neoplasms are extremely rare [ [1] , [2] ].…”

“…Intracranial metastases are extremely rare lesions of gastro intestinal stromal tumors (GIST). Few cases were reported in the English literature [ [1] , [2] ]. GIST Metastases usually occur on the liver and the peritoneum [ [3] , [4] ].…”

Metastatic Cerebellar Gastrointestinal Stromal Tumor with Obstructive Hydrocephalus Arising from the Small Intestine: A Case Report and Review of the Literature

“…As shown in Table 1 , only 16 cases (including the present) have been reported in the literature [ 8 – 22 ].…”

“…Following resistance to imatinib mesylate, sunitinib, a multitargeted small-molecule tyrosine kinase inhibitor that selectively blocks vascular endothelial growth factor receptors (VEGFRs) with potent activity against KIT and PDGFA, has proven effective as a second-line therapy and is currently approved worldwide for metastatic GIST in patients with imatinib resistance or intolerance [ 7 , 8 ]. Unlike imatinib mesylate, sunitinib has the ability to penetrate the BBB [ 8 , 27 , 28 ], making this the treatment of choice when GIST is not amenable to surgery or the patient has uncontrolled lesions.…”

“…However, imatinib mesylate is believed to be ineffective against brain metastases, because it cannot pass through the blood-brain barrier (BBB) and does not achieve adequate levels in the brain when administered in lower concentrations [ 6 ]. As a second-line treatment, sunitinib, a multitargeted small-molecule tyrosine kinase inhibitor, has been shown to be effective and is currently approved worldwide for metastatic GIST [ 7 , 8 ].…”