Liver transplantation for metastatic wild-type gastrointestinal stromal tumor in the era of molecular targeted therapies: Report of a first case

Abstract

The gastrointestinal stromal tumor (GIST) is a digestive neoplasm of mesenchymal lineage. The treatment strategy for receptor tyrosine kinase‐mutated GISTs is well defined. Wild‐type GISTs (WT‐GISTs) respond unsatisfactorily to specific kinase inhibitors. Moreover, evidence shows that repeat surgery has limited benefit. We report the case of a young female patient who was diagnosed with liver metastatic WT‐GIST, after initial radical resection and adjuvant therapy with molecular targeted drugs. Due to the disease progression, a two‐stage surgery was performed, with the removal of extrahepatic lesions followed by a total hepatectomy. The patient is disease‐free after 4 years from liver transplantation (LT), performed under everolimus‐based immunosuppression. The treatment of WT‐GISTs remains a significant challenge due to the frequent resistance to tyrosine kinase inhibitors (TKIs). Liver transplantation might represent an effective treatment option for such disease.

Living Donor Liver Transplantation for Imatinib‐Resistant Gastrointestinal Stromal Tumor Liver Metastases: A New Therapeutic Option in Transplant Oncology

“…(3) Recently, Iesari et al reported a case of wild-type metastatic GIST that was treated with a partial gastrectomy. (2) However, liver metastasis appeared under treatment with sorafenib. In the follow-up period, the patient received imatinib, sunitinib, nilotinib, and sorafenib in an attempt to control the slow tumor progression.…”

“…Only a few cases of patients undergoing LT for metastatic GIST have been reported. (1)(2)(3)(4) We report a patient diagnosed with massive gastricorigin GIST liver metastases unresponsive to imatinib treatment, who received a living donor LT 5 years after a subtotal gastrectomy, with no posttransplant recurrence after 41 months of follow-up.…”

Living Donor Liver Transplantation for Imatinib‐Resistant Gastrointestinal Stromal Tumor Liver Metastases: A New Therapeutic Option in Transplant Oncology

“…Recently, another case report on the LT in KIT/ PDGFRA WT GIST was published, (5) but as already discussed, in the growing era of molecular-based therapies, interdisciplinary management with oncologists and transplant surgeons is necessary to improve the results of treatment and clinical practice.…”

Letter to the editor concerning “Liver transplantation for metastatic wild-type gastrointestinal stromal tumor in the era of molecular targeted therapies: Report of a first case"

“…A case report by Iesari et al states that liver transplantation (LT) could be an effective treatment option for liver metastatic wild‐type (WT) gastrointestinal stromal tumor (GIST) 1 …”

“…A case report by Iesari et al states that liver transplantation (LT) could be an effective treatment option for liver metastatic wild-type (WT) gastrointestinal stromal tumor (GIST). 1 Although we find this therapeutic approach very challenging, we believe that this statement requires some clarifications due to the following observations.…”