Asian Consensus Guidelines for the Diagnosis and Management of Gastrointestinal Stromal Tumor

Koo, Dong Hoe; Ryu, Min Hee; Kim, Kyoung Mee; Yang, Han Kwang; Sawaki, Akira; Hirota, Seiichi; Zheng, Jie; Zhang, Bo; Tzen, Chin Yuan; Yeh, Chun‐Nan; Nishida, Toshirou; Shen, Lin; Chen, Li Tzong; Kang, Yoon Koo

doi:10.4143/crt.2016.187

Cited by 165 publications

(209 citation statements)

References 72 publications

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“…Most recently, the Asian Consensus Guidelines (2016) for the Diagnosis and Management of GISTs was published to promote optimal care for Asian populations[51]. …”

Section: Current Treatment Guidelines For Gistsmentioning

confidence: 99%

Current research and treatment for gastrointestinal stromal tumors

Lim

Tan

2017

WJG

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract and have gained considerable research and treatment interest, especially in the last two decades. GISTs are driven by mutations commonly found in the KIT gene and less commonly in the platelet-derived growth factor receptor alpha gene, BRAF gene and succinate dehydrogenase gene. GISTs behave in a spectrum of malignant potential, and both the tumor size and mitotic index are the most commonly used prognostic criteria. Whilst surgical resection can offer the best cure, targeted therapy in the form of tyrosine kinase inhibitors (TKIs) has revolutionized the management options. As the first-line TKI, imatinib offers treatment for advanced and metastatic GISTs, adjuvant therapy in high-risk GISTs and as a neoadjuvant agent to downsize large tumors prior to resection. The emergence of drug resistance has altered some treatment options, including prolonging the first-line TKI from 1 to 3 years, increasing the dose of TKI or switching to second-line TKI. Other newer TKIs, such as sunitinib and regorafenib, may offer some treatment options for imatinib-resistant GISTs. New molecular targeted therapies are being evaluated, such as inhibitors of BRAF, heat shock protein 90, glutamine and mitogen-activated protein kinase signaling, as well as inhibitors of apoptosis proteins antagonist and even immunotherapy. This editorial review summarizes the recent research trials and potential treatment targets that may influence our future patient-specific management of GISTs. The current guidelines in GIST management from Europe, North America and Asia are highlighted.

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“…Most recently, the Asian Consensus Guidelines (2016) for the Diagnosis and Management of GISTs was published to promote optimal care for Asian populations[51]. …”

Section: Current Treatment Guidelines For Gistsmentioning

confidence: 99%

Current research and treatment for gastrointestinal stromal tumors

Lim

Tan

2017

WJG

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“…For medical treatment, the Asian and Western guidelines are very similar in recommending first-line imatinib, second-line sunitinib, and third-line regorafenib, as described above [3,4,6,11]. However, most of the evidence supporting these recommendations has been established by clinical trials conducted in the Western countries, and Asian GIST patients may still require their own evidence for some aspects, such as dose optimization.…”

Section: Molecular Targeted Drug Therapy In Gistsmentioning

confidence: 99%

“…A systematic review of population-based cohort studies on GISTs showed that the incidence ranges from a low 0.43 per 100,000/year in the Shanxi Province, China, to a high 1.6-2.2 per 100,000/year in South Korea [4,5,6]. The cohort of 13,550 patients from 19 countries studied in this review gave the reported age as ranging from 10-100 years, with a median age in the 60s; both male and female populations had approximately equal distribution [7].…”

Section: Introductionmentioning

confidence: 99%

Standard Approach to Gastrointestinal Stromal Tumors - Differences between China and Europe

Tu¹,

Hohenberger²,

Allgayer³

et al. 2018

Visc Med

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. With the considerable research and application of molecular-targeted therapy for GISTs in the last two decades, GISTs have become a model of multidisciplinary oncological treatment. Although Western clinical guidelines are available for GISTs, such as those by the European Society of Medical Oncology (ESMO), the clinical situations in China are different from those in European countries. There are distinct differences between the clinical practice, diagnostic methods, surgical approach, and availability of new targeted agents in China and those in Europe. This review summarizes the Chinese GIST consensus guidelines compared to the European ones, which may provide an optimal approach to the diagnosis and management of GIST patients.

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“…However, several studies have reported that small GIST of <2 cm in diameter may exhibit malignant potential, and this potential cannot be accurately assessed based on their size and location . Endoscopic ultrasound (EUS) can provide much information of the tumors, including their morphology, size, originating gastrointestinal wall layers, borders, and echogenicity; therefore, this technique has been recommended for detecting and staging submucosal neoplasms . Nevertheless, using conventional EUS, it is difficult to discriminate between GIST and benign subepithelial lesions, such as leiomyoma, and to determine the malignant potential of GIST.…”

Section: Introductionmentioning

confidence: 99%

Value of contrast‐enhanced harmonic endoscopic ultrasonography in differentiating between gastrointestinal stromal tumors: A meta‐analysis

Tang

Tao

Zhang

et al. 2019

J of Digest Diseases

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Objective Contrast‐enhanced harmonic endoscopic ultrasonography (CH‐EUS) is a valuable device to diagnose and determine the malignant potential of gastrointestinal stromal tumors (GIST) as early as possible when making clinical therapeutic decisions. This study aimed to estimate the ability of CH‐EUS to discriminate between GIST and benign submucosal lesions (SML) and to predict their malignant potential. Methods PubMed, MEDLINE, EMBASE, the Web of Science, and Cochrane Central Register of Controlled Trials databases were screened. Using the data provided in the literatures, 2 × 2 tables were constructed to obtain the pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. A receiver operating characteristic (ROC) curve was generated and the area under the ROC curve (AUROC) was calculated. Results Four studies with a total of 187 patients were identified to evaluate the value of CH‐EUS in discriminating between GIST and benign SML. The pooled sensitivity, specificity, and AUROC were 89% (95% CI 0.82‐0.93), 82% (95% CI 0.66‐0.92), and 0.89, respectively. Five studies including 143 patients were analyzed to assess the accuracy of CH‐EUS in determining the malignant potential of GIST. The pooled sensitivity, specificity, and AUROC curve of CH‐EUS were 96% (95% CI 0.90‐0.99), 53% (95% CI 0.40‐0.66), and 0.92, respectively. Conclusions CH‐EUS is a safe, noninvasive method that can distinguish between GIST and benign subepithelial lesions and to predict their malignant potential to a certain extent. Large‐scale, multicenter prospective studies are needed in the future.

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Asian Consensus Guidelines for the Diagnosis and Management of Gastrointestinal Stromal Tumor

Cited by 165 publications

References 72 publications

Current research and treatment for gastrointestinal stromal tumors

Current research and treatment for gastrointestinal stromal tumors

Standard Approach to Gastrointestinal Stromal Tumors - Differences between China and Europe

Value of contrast‐enhanced harmonic endoscopic ultrasonography in differentiating between gastrointestinal stromal tumors: A meta‐analysis

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