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09-10-2023 | Imatinib | Sarcoma

Neoadjuvant Imatinib in Locally Advanced Gastrointestinal Stromal Tumors (GISTs) is Effective and Safe: Results from a Prospective Single-Center Study with 108 Patients

Authors: Stijn J. C. van der Burg, MD, Deborah van de Wal, MD, Evelyne Roets, MD, Neeltje Steeghs, MD, PhD, Johanna W. van Sandick, MD, PhD, Martijn Kerst, MD, PhD, Frits van Coevorden, MD, Koen J. Hartemink, MD, PhD, Xander A. A. F. A. Veenhof, MD, PhD, Anne Miek Koenen, MANP, Nikki Ijzerman, MD, PhD, Winette T. A. van der Graaf, MD, Yvonne M. Schrage, MD, PhD, Winan J. van Houdt, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2023

Abstract

Background

Neoadjuvant imatinib is considered for gastrointestinal stromal tumors (GISTs) when decreased tumor size provides less extensive surgery and higher R0 resection rates. This study evaluates the effectivity and safety of neoadjuvant imatinib for large or locally advanced GIST.

Patients and Methods

From the prospective database of the Dutch GIST Consortium, all patients who underwent surgery after neoadjuvant imatinib at our center between 2009 and 2022 were selected. Independent and blinded assessment of surgical strategy was performed by two surgeons, based on anonymized computed tomography (CT) scans before and after neoadjuvant imatinib.

Results

Of 113 patients that received neoadjuvant imatinib, 108 (95%) [mean age 61.6, standard deviation (SD) 11.5, 54% male] underwent a GIST resection. Of all GISTs, 67% was localized in the stomach and 25% in the duodenum or small intestine. In 74% of the patients with GIST, a KIT exon 11 mutation was found. Decreased tumor size was seen in 95 (88%) patients. Having a KIT exon 11 mutation [odds ratio (OR) 5.64, 95% confidence interval (CI) 1.67–19.1, p < 0.01] or not having a mutation (OR 0.19, 95% CI 0.04–0.89, p = 0.04) were positive and negative predictive values for partial response, respectively. In 55 (51%) patients, there was deescalation of surgical strategy after neoadjuvant imatinib. Surgical complications were documented in 16 (15%) patients (n = 8, grade II; n = 5, grade IIIa; n = 3, grade IIIb) and R0 resection was accomplished in 95 (89%) patients. The 5-year disease-free and overall survival were 80% and 91%, respectively.

Conclusion

This study shows that neoadjuvant imatinib is effective and safe for patients with large or locally advanced GIST.

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Title: Neoadjuvant Imatinib in Locally Advanced Gastrointestinal Stromal Tumors (GISTs) is Effective and Safe: Results from a Prospective Single-Center Study with 108 Patients
Authors: Stijn J. C. van der Burg, MD
Deborah van de Wal, MD
Evelyne Roets, MD
Neeltje Steeghs, MD, PhD
Johanna W. van Sandick, MD, PhD
Martijn Kerst, MD, PhD
Frits van Coevorden, MD
Koen J. Hartemink, MD, PhD
Xander A. A. F. A. Veenhof, MD, PhD
Anne Miek Koenen, MANP
Nikki Ijzerman, MD, PhD
Winette T. A. van der Graaf, MD
Yvonne M. Schrage, MD, PhD
Winan J. van Houdt, MD, PhD
Publication date: 09-10-2023
Publisher: Springer International Publishing
Keywords: Imatinib
Gastrointestinal Stromal Tumor
Published in: Annals of Surgical Oncology / Issue 13/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-14346-x

At a glance: The STEP trials

Springer Medicine

Neoadjuvant Imatinib in Locally Advanced Gastrointestinal Stromal Tumors (GISTs) is Effective and Safe: Results from a Prospective Single-Center Study with 108 Patients

Abstract

Background

Patients and Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusion

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