Preoperative imatinib treatment in patients with locally advanced and metastatic/recurrent gastrointestinal stromal tumors

Abstract

The advent of imatinib mesylate (IM) has dramatically revolutionized the prognosis of advanced and metastatic/recurrent gastrointestinal stromal tumors (GISTs). The objective of this retrospective study is to investigate the safety and efficacy of combination of surgery following IM treatment in the management of advanced and metastatic/recurrent GISTs. We further explore the long-term clinical outcomes in these who underwent therapy of preoperative IM. Eligible patients with GISTs before the onset of the IM therapy and were periodically followed up in the outpatient clinic were included in this study. Detailed clinical and pathologic characteristics were obtained from the medical records of our institution. Univariate and multivariate regression analyses were performed to use for the evaluation of potential prognostic factors. A total of 51 patients were included in the study, of these patients, 36 patients underwent surgery and median duration of preoperative IM is 8.2months (range 3.5–85 months). Significant median tumor shrinkage rate was 29.27% (95% confidence interval 21.00%–34.00%) observed in these patients who responded to IM, and partial response and stable disease were achieved in 24 patients (47.06%) and 23 patients (45.10%), respectively, in light of the RECIST guideline (version 1.1). After the median follow-up of 43.70 months (range 14.2–131.1 months), 1- and 3-year overall survival (OS) were estimated to be 96.1% and 94.0%, respectively, and there was a significant improvement in OS for patients who received surgical intervention versus those who did not. Our study consolidates that patients were received preoperative IM therapy could shrink the size of tumors and facilitate organ-function preservation. The long-term analysis on this study supports that surgical intervention following IM therapy benefits for patients with primary advanced and recurrent or metastatic GISTs on long-term prognosis.

Dermatofibrosarcoma Protuberans: Update on the Diagnosis and Treatment

“…Further studies showed that IM used as a preoperative adjuvant therapy in DFSP lead to median tumor volume shrinkages from 20% to 31.5% [ 39 , 107 , 113 , 114 ], which transformed very large, unresectable tumors into resectable ones. Wang et al reported four of 10 patients with primarily unresectable DFSP received complete surgical resection following IM treatment [ 38 ].…”

Recent advances in the management of gastrointestinal stromal tumor

“…Follow-up imaging should be done to evaluate for treatment response. Wang et al[ 80 ] did a single center analysis in which patients with advanced and metastatic/recurrent GISTs were given imatinib mesylate for a median period of 8.2 mo preoperatively and tumor shrinkage was observed in almost 30% of cases. If the response is good and the disease remains stable, continue imatinib or avapritinib, and surgery consult should be done to consider resection.…”

Surgery Prolongs the Survival of Patients with Metastatic, Recurrent, or Unresectable Locally Advanced Gastrointestinal Stromal Tumors Response to Imatinib Mesylate Treatment: A Systematic Review and Meta-analysis

“…A total of 10 studies [25][26][27][28][29][30][31][32][33][34] including 1119 patients (361 patients in the surgery group and 758 patients in the no surgery group) met the eligibility criteria and were included in the nal analysis (Figure 1). Manual searches of the references lists of the included studies did not yield any further studies.…”

“…One randomized control trial 28 and 4 retrospective studies 27,30,33,34 with scores of six or higher on the NOS were included in the sensitivity analysis. The results related to OS and PFS did not changed signi cantly in the sensitivity analysis (shown in supplementary material Figure S1 and Figure S2).…”