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Role of Surgery Combined with Kinase Inhibition in the Management of Gastrointestinal Stromal Tumor (GIST)

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Surgery is the standard treatment for primary, gastrointestinal stromal tumor (GIST); however, surgical resection often is not curative, particularly in large GIST. Five years after complete removal of their tumor, approximately half of treated patients relapse. Imatinib, an oral tyrosine kinase inhibitor (TKI), is first-line treatment in patients with metastatic or unresectable GIST. It has resulted in durable objective responses or stable disease in 84% of patients and is well tolerated. The efficacy of imatinib in advanced GIST has created interest in a variety of potential multimodal approaches to management that combine surgery with systemic therapy.

Results

Recently, a large, randomized, Phase III, US cooperative group trial that compared adjuvant imatinib, for 1 year after primary complete surgical resection, with placebo in primary GIST, reported a significantly shorter time to relapse for those in the placebo group. This led to the approval of imatinib for this new indication in the US and Europe. Several studies evaluating the efficacy of adjuvant imatinib in patients with primary GIST who are at high risk for postoperative relapse are ongoing; in particular two large European studies are expected to yield preliminary results in the near future. Neoadjuvant therapy with imatinib is also being investigated for its effect on surgical outcomes, with first trial results reported.

Conclusion

This article provides an update on the rapidly evolving role of surgery, treatment with TKI therapy, and their combination in the management of GIST as well as further reviews pertinent to current clinical research findings.

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Acknowledgment

The authors would like to thank Michael Pellegrino, PhD, who provided technical writing assistance with support from Novartis Pharmaceuticals.

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Authors and Affiliations

  1. Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, Mannheim University Medical Center, University of Heidelberg, Mannheim, Germany

    Peter Hohenberger MD, PhD

  2. Norris Cotton Cancer Center and Dartmouth Medical School, Dartmouth–Hitchcock Medical Center, Lebanon, New Hampshire

    Burton Eisenberg MD

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  1. Peter Hohenberger MD, PhD
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  2. Burton Eisenberg MD
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Correspondence to Peter Hohenberger MD, PhD.

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Hohenberger, P., Eisenberg, B. Role of Surgery Combined with Kinase Inhibition in the Management of Gastrointestinal Stromal Tumor (GIST). Ann Surg Oncol 17, 2585–2600 (2010). https://doi.org/10.1245/s10434-010-1053-9

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