Adjuvant therapy of gastrointestinal stromal tumors

Current Opinion in Oncology
Vadim P Koshenkov, Steven E Rodgers

Abstract

The treatment of gastrointestinal stromal tumors (GISTs) with tyrosine kinase inhibitors (TKIs), such as imatinib and sunitinib, has produced improved outcomes and survival. However, patients with high-risk tumors still have unacceptably high rates of recurrence and disease progression. In the current review, we examine the various strategies for optimizing the treatment of GISTs. Extended duration of treatment (36 months) with adjuvant imatinib resulted in improved recurrence-free survival and overall survival, whereas discontinuation of the TKI led to relapse of disease in most high-risk patients. High-dose therapy of imatinib was beneficial for patients with KIT exon 9 mutations. Patients with KIT exon 11 mutations experienced the most improvement in outcomes from adjuvant imatinib. The extended duration of TKI treatment, dose optimization, mutation status, and the effects of TKI discontinuation have recently been examined in more detail. As our understanding of TKI therapy grows, an individualized approach to each patient should lead to better outcomes.

References

Mar 24, 2009·Lancet·Ronald P DematteoUNKNOWN American College of Surgeons Oncology Group (ACOSOG) Intergroup Adjuvant GIST Study Team
May 20, 2009·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·George D DemetriMargaret von Mehren
Nov 10, 2009·Annals of Surgical Oncology·Chandrajit P RautMonica M Bertagnolli
Feb 4, 2010·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·UNKNOWN Gastrointestinal Stromal Tumor Meta-Analysis Group (MetaGIST)
Feb 24, 2010·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Changhoon YooYoon-Koo Kang
Mar 10, 2010·European Journal of Cancer : Official Journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)·Axel Le CesneOlivier Hermine
Mar 30, 2010·Annals of Oncology : Official Journal of the European Society for Medical Oncology·R K PandurenganJ C Trent
Aug 24, 2010·The British Journal of Surgery·P HohenbergerP Reichardt
Feb 1, 2011·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·J LiL Shen
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Dec 15, 2011·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·Pauline LagardeFrédéric Chibon

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Citations

Jan 7, 2014·European Journal of Cancer : Official Journal for European Organization for Research and Treatment of Cancer (EORTC) [and] European Association for Cancer Research (EACR)·Atul B ShinagareNikhil H Ramaiya
Aug 15, 2013·Clinical Cancer Research : an Official Journal of the American Association for Cancer Research·Sebastian F SchoppmannPeter Birner

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