Clinical significance of surgical intervention for imatinib-resistant gastrointestinal stromal tumors in the era of multiple tyrosine kinase inhibitors
- 11 February 2021
- journal article
- research article
- Published by Springer Science and Business Media LLC in Surgery Today
- Vol. 51 (9), 1506-1512
- https://doi.org/10.1007/s00595-021-02241-5
Abstract
Purpose Imatinib is the standard treatment for unresectable and metastatic GIST. In the late stages, patients undergoing imatinib show drug resistance. Surgical intervention has been occasionally performed for resistant lesions. However, the clinical significance of such intervention remains unclear. Methods Between 2006 and 2015, 37 patients were diagnosed with imatinib-resistant GISTs. We performed surgical intervention only for localized resistant lesions. We retrospectively investigated the background characteristics, data on surgical intervention and subsequent treatment, progression-free survival (PFS), and overall survival (OS). Results Eighteen patients diagnosed with localized resistance received surgical intervention (S-group) and 19 patients diagnosed with generalized resistance were received other TKIs (M-group). In S-group, no serious complications occurred, and all patients restarted imatinib after resection. The median PFS was 14.5 months. Five patients underwent surgical intervention multiple times followed by the continuation of imatinib, and the median duration of imatinib continuation was 22.2 months. Second-line TKIs were administered to 93% of the patients and the dose-intensity and outcome were similar in both groups. The median OS was 47.2 months after surgery. Conclusions Surgical intervention could be performed safely and therefore could be followed by the continuation of TKI therapy. Surgical intervention based on the appropriate criteria of resistance might thus be useful for imatinib-resistant GISTs.Keywords
This publication has 18 references indexed in Scilit:
- Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib (GRID): an international, multicentre, randomised, placebo-controlled, phase 3 trialThe Lancet, 2013
- The efficacy of PET-CT for predicting the malignant potential of gastrointestinal stromal tumorsSurgery Today, 2012
- Surgical management in metastatic gastrointestinal stromal tumor (GIST) patients after imatinib mesylate treatmentJournal of Surgical Oncology, 2010
- Gastrointestinal stromal tumor: a bridge between bench and bedsideGastric Cancer, 2009
- Post-imatinib surgery in advanced/metastatic GIST: is it worthwhile in all patients?Annals of Oncology, 2009
- Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English versionInternational Journal of Clinical Oncology, 2008
- Surgical interventions for focal progression of advanced gastrointestinal stromal tumors during imatinib therapyInternational Journal of Clinical Oncology, 2007
- Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: a randomised controlled trialThe Lancet, 2006
- Surgical Management of Advanced Gastrointestinal Stromal Tumors After Treatment With Targeted Systemic Therapy Using Kinase InhibitorsJournal of Clinical Oncology, 2006
- Classification of Surgical ComplicationsAnnals of Surgery, 2004