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Multidisciplinary treatment of GIST |
Bulletin du Cancer. Volume 93, Number 4, 181-9, Numéro spécial, Mars 2006, Synthèse
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 Résumé
Article gratuit
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Author(s) : Isabelle Ray-Coquard, Chadi Saba, Françoise Ducimetière, Cyril Confavreux, Fhadi Rustam, Pierre Méeus, Jean-François Brantus, Dominique Ranchère-Vince, Philippe Thiesse, Jérome Fayette, Jean-Yves Scoazec, Pierre-Paul Bringuier, Jean-Michel Coindre, Binh Bui, Sylvie Bonvalot, Jean-Yves Blay, Pierre Biron, Axel Le Cesne |
Summary : Gastrointestinal stromal tumors (GIST) are rare tumors occuring at all levels of the gastrointestinal tract, representing 10 to 50% of all soft tissue sarcomas. The introduction of imatinib, an orally administered inhibitor of the KIT receptor tyrosine kinase, is prompting revision of the management algorithms that have traditionally guided the treatment of (GIST). Rapidly accruing phase I, II and III trials in the USA and Europe (EORTC) have demonstrated since 2000 that imatinib mesylate (STI571) is an active agent in GIST with an initial response rate of 70% and 10% only of primary refractory tumors, yelding an improved overall survival as compared to historical series. Resistance are now being observed however. Numerous question regarding the integration of this treatment with surgery and the long term outcome of these patients still remain to be answered however. These encouraging results have led to the initiation of clinical trials of imatinib as an adjuvant or neoadjuvant therapy with surgery. Until relevant data are reported to provide definitive direction for the management of operable or potentially operable GISTs, treatment decisions must be made on the basis of the available evidence and clinical experience with imatinib. This paper presents selected case studies describing approaches to the combined use of surgery and systemic therapy that have been applied in the treatment of individual GIST patients. The management of GIST in these cases required a coordinated, multidisciplinary approach involving medical oncologists, diagnostic radiologists, gastroenterologists, surgeons, and pathologists. |
Keywords : gastrointestinal stromal tumor, imatinib, surgery |
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