Hépato-Gastro & Oncologie Digestive


Tumor progression in treated metastatic GIST : How to monitor it and to manage it? Volume 23, issue 4, Avril 2016


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1 Gustave Roussy, département de médecine, 114 rue Edouard Vaillant, 94800 Villejuif, France
2 Institut Claudius Régaud, département de médecine, Toulouse, France
3 Hôpital de la Timone, département d’oncologie médicale, Marseille, France
4 Hôpital Ambroise Paré, service de pathologie, Université de Versailles, Boulogne, France
5 Centre Georges-François Leclerc, département d’oncologie médicale, Dijon, France
6 Hôpitaux Civils Universitaires Strasbourg, département d’oncologie médicale et d’hématologie, Strasbourg, France
7 Hôpital Européen Georges Pompidou, département d’oncologie, Paris, France
8 Institut Bergonié, département d’oncologie médicale, Bordeaux, France
9 Centre Oscar Lambret, département de radiologie, Lille, France
* Tirés à part

Treatment of metastatic GIST is based on tyrosine kinase inhibitors (TKIs). Despite the activity of these TKIs, prognosis of advanced GIST remains dismal and, as only three treatment lines are available, each of them has to be optimized before interrupting and or changing treatment.

Four progression types are individualized, depending on clinical symptoms and radiological aspects. The clinician has to assess progression by using robust radiological taking into account both tumor size and density.

Still underutilized, dynamic contrast-enhanced ultrasound is the most sensible technique to evaluate GIST progression.

Analysis of progression kinetics is critical because it will condition the subsequent management. When facing progressive disease, clinicians have to ensure that compliance is optimal and that there is no drug-drug interaction. Plasmatic dosages of medication are highly useful in this context. Finally, modifications of therapeutic scheme or local treatment have to be considered.