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01-05-2012 | Gastrointestinal Oncology

Patterns of Care, Prognosis, and Survival in Patients with Metastatic Gastrointestinal Stromal Tumors (GIST) Refractory to First-Line Imatinib and Second-Line Sunitinib

Authors: Antoine Italiano, MD, PhD, Angela Cioffi, MD, Paola Coco, MD, Robert G. Maki, MD, PhD, Patrick Schöffski, MD, PhD, Piotr Rutkowski, MD, Axel Le Cesne, MD, Florence Duffaud, MD, Antoine Adenis, MD, Nicolas Isambert, MD, Emmanuelle Bompas, MD, Jean-Yves Blay, MD, PhD, Paolo Casali, MD, Mary Louise Keohan, MD, Maud Toulmonde, MD, Cristina R. Antonescu, MD, Maria Debiec-Rychter, MD, PhD, Jean-Michel Coindre, MD, PhD, Binh Bui, MD

Published in: Annals of Surgical Oncology | Issue 5/2012

Abstract

Background

Data regarding the management and outcome of patients with metastatic gastrointestinal stromal tumors (GIST) refractory to 1st-line imatinib and 2nd-line sunitinib are limited.

Methods

Medical records of 223 imatinib-resistant and sunitinib-resistant GIST who were treated in 11 major referral centers were reviewed.

Results

The three most frequent drugs used in the 3rd-line setting were: nilotinib n = 67 (29.5%), sorafenib n = 55 (24.5%), and imatinib n = 40 (17.5%). There were 18 patients (8%) who received best supportive care (BSC) only. The median progression-free survival (PFS) and overall survival (OS) on 3rd-line treatment were 3.6 months [95% confidence interval (95% CI), 3.1–4.1] and 9.2 months (95% CI, 7.5–10.9), respectively. Multivariate analysis showed that, in the 3rd-line setting, albumin level and KIT/PDGFRA mutational status were significantly associated with PFS, whereas performance status and albumin level were associated with OS. After adjustment for prognostic factors, nilotinib and sorafenib provided the best PFS and OS. Rechallenge with imatinib was also associated with improved OS in comparison with BSC.

Conclusion

In the 3rd-line setting, rechallenge with imatinib provided limited clinical benefit but was superior to BSC. Sorafenib and nilotinib have significant clinical activity in imatinib-resistant and sunitinib-resistant GIST and may represent an alternative for rechallenge with imatinib.

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Title: Patterns of Care, Prognosis, and Survival in Patients with Metastatic Gastrointestinal Stromal Tumors (GIST) Refractory to First-Line Imatinib and Second-Line Sunitinib
Authors: Antoine Italiano, MD, PhD
Angela Cioffi, MD
Paola Coco, MD
Robert G. Maki, MD, PhD
Patrick Schöffski, MD, PhD
Piotr Rutkowski, MD
Axel Le Cesne, MD
Florence Duffaud, MD
Antoine Adenis, MD
Nicolas Isambert, MD
Emmanuelle Bompas, MD
Jean-Yves Blay, MD, PhD
Paolo Casali, MD
Mary Louise Keohan, MD
Maud Toulmonde, MD
Cristina R. Antonescu, MD
Maria Debiec-Rychter, MD, PhD
Jean-Michel Coindre, MD, PhD
Binh Bui, MD
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 5/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-011-2120-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Patterns of Care, Prognosis, and Survival in Patients with Metastatic Gastrointestinal Stromal Tumors (GIST) Refractory to First-Line Imatinib and Second-Line Sunitinib

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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