Neoadjuvant therapy for gastrointestinal stromal tumor

Ishikawa, Takashi; Kanda, Tatsuo; Kameyama, Hitoshi; Wakai, Toshifumi

doi:10.21037/tgh.2018.01.01

Cited by 20 publications

(24 citation statements)

References 36 publications

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“…The criteria to be used to recommend neoadjuvant treatment in GIST remain to be determined [43,44]. Treatment decisions are dependent on numerous factors, such as tumor size, tumor position, the existence of metastases, and the performance status of the patient.…”

Section: Discussionmentioning

confidence: 99%

Pretreatment Tumor DNA Sequencing of KIT and PDGFRA in Endosonography-Guided Biopsies Optimizes the Preoperative Management of Gastrointestinal Stromal Tumors

et al. 2020

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Background Neoadjuvant tyrosine kinase inhibitor (TKI) therapy increases the chance of organ-preserving, radical resection in selected patients with gastrointestinal stromal tumors (GISTs). We aimed to evaluate systematic, immediate DNA sequencing of KIT and PDGFRA in pretreatment GIST tissue to guide neoadjuvant TKI therapy and optimize preoperative tumor response. Methods All patients who were candidates for neoadjuvant therapy of a suspected GIST [the study cohort (SC)] were prospectively included from January 2014 to March 2018. Patients were subjected to pretreatment endosonography-guided fine-needle biopsy (EUS-FNB) or transabdominal ultrasound-guided needle biopsy (TUS-NB), followed by immediate tumor DNA sequencing (< 2 weeks). A historic (2006-2013) reference cohort (RC) underwent work-up without sequencing before neoadjuvant imatinib (n = 42). The rate of optimal neoadjuvant therapy (Therapy OPTIMAL) was calculated, and the induced tumor size reduction (Tumor Regression MAX , %) was evaluated by computed tomography (CT) scan. Results The success rate of pretreatment tumor DNA sequencing in the SC (n = 81) was 77/81 (95%) [EUS-FNB 71/74 (96%); TUS-NB 6/7 (86%)], with mutations localized in KIT (n = 58), PDGFRA (n = 18), or neither gene, wild type (n = 5). In patients with a final indication for neoadjuvant therapy, the Therapy OPTIMAL was higher in the SC compared with the RC [61/63 (97%) versus 33/42 (79%), p = 0.006], leading to a significantly higher Tumor Regression MAX in patients treated with TKI (27% vs. 19%, p = 0.015). Conclusions Pretreatment endosonography-guided biopsy sampling followed by immediate tumor DNA sequencing of KIT and PDGFRA is highly accurate and valuable in guiding neoadjuvant TKI therapy in GIST. This approach minimizes maltreatment with inappropriate regimens and leads to improved tumor size reduction before surgery.

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Section: Discussionmentioning

confidence: 99%

Pretreatment Tumor DNA Sequencing of KIT and PDGFRA in Endosonography-Guided Biopsies Optimizes the Preoperative Management of Gastrointestinal Stromal Tumors

et al. 2020

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“…There is no consensus on the use of neoadjuvant therapy for the treatment of GISTs. There have been approximately seven trials in which neoadjuvant chemotherapy was studied and utilized [ 9 ]. RTOG (Radiation Therapy Oncology Group) 0132 was the first trial of preoperative imatinib in GIST [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Imatinib was administered at 600 mg/day for 8 to 12 weeks before surgery, and imatinib administration also continued for 2 years after surgery. In the primary GIST group, the progression-free survival, which was the primary end point of this trial, was calculated as 83.9% for 2 years and 56.7% for 5 years [ 9 , 10 ]. This was the first trial to show some use of neoadjuvant imatinib, but unfortunately, the same trial failed to show any superiority of adding neoadjuvant chemotherapy compared to adjuvant alone [ 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the primary GIST group, the progression-free survival, which was the primary end point of this trial, was calculated as 83.9% for 2 years and 56.7% for 5 years [ 9 , 10 ]. This was the first trial to show some use of neoadjuvant imatinib, but unfortunately, the same trial failed to show any superiority of adding neoadjuvant chemotherapy compared to adjuvant alone [ 9 , 10 ]. Kurokawa et al had similar results in a recent study published in 2017 that showed that neoadjuvant therapy along with surgery may be beneficial long term [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

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Gigantic GIST: A Case of the Largest Gastrointestinal Stromal Tumor Found to Date

Mohamed

Botros

Hanna

et al. 2018

Case Reports in Surgery

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Gastrointestinal stromal tumors are uncommon when compared to all gastrointestinal neoplasms but are the most common mesenchymal tumors of the gastrointestinal tract. The largest gastrointestinal stromal tumor ever recorded in literature weighed approximately 6.1 kg and measured 39 cm × 27 cm × 14 cm. About two-thirds of GISTs are malignant. The tumor size, mitotic rate, cellularity, and nuclear pleomorphism are the most important parameters when considering prognosis and recurrence. The definitive treatment for these tumors is resection. In the year 2000, the first patient was treated with the tyrosine kinase inhibitor imatinib and since then, gastrointestinal stromal tumors with high-risk features have been treated successfully with tyrosine kinase inhibitors. We present the largest gastrointestinal stromal tumor recorded in medical literature measuring 42.0 cm × 31.0 cm × 23.0 cm in maximum dimensions and weighing in at approximately 18.5 kg in a 65-year-old African-American male who presented with increased abdominal distention. The mass was successfully excised, and the patient was treated with imatinib without local or distant recurrence 1.5 years postoperatively.

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“…However, proof of the survival and effectiveness of neoadjuvant imatinib has not been sufficiently justified. Tumor biopsy should be performed to confirm the diagnosis and tumor genotype before establishing a neoadjuvant treatment [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Coexistence of Primary GEJ Adenocarcinoma and Pedunculated Gastric Gastrointestinal Stromal Tumor

Alkaaki

Abdulhadi

Aljiffry

et al. 2018

Case Reports in Surgery

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Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the digestive system, although they account for only 0.1–3% of all gastrointestinal (GI) malignancies. They can arise anywhere along the GI tract with gastric predominance. Concurrent occurrence of GIST and gastroesophageal junction (GEJ) neoplasm is rare. We report a 55-year-old gentleman presenting with a polyp at the GEJ and a synchronous, large, and pedunculated gastric mass at the greater curvature. Those were treated with a wedge resection of the gastric pedunculated mass with negative margins along with transgastric submucosal resection of the GEJ polyp. Pathological examination confirmed synchronous invasive GEJ adenocarcinoma and a high-grade gastric GIST.

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Neoadjuvant therapy for gastrointestinal stromal tumor

Cited by 20 publications

References 36 publications

Pretreatment Tumor DNA Sequencing of KIT and PDGFRA in Endosonography-Guided Biopsies Optimizes the Preoperative Management of Gastrointestinal Stromal Tumors

Pretreatment Tumor DNA Sequencing of KIT and PDGFRA in Endosonography-Guided Biopsies Optimizes the Preoperative Management of Gastrointestinal Stromal Tumors

Gigantic GIST: A Case of the Largest Gastrointestinal Stromal Tumor Found to Date

Coexistence of Primary GEJ Adenocarcinoma and Pedunculated Gastric Gastrointestinal Stromal Tumor

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