Advances of diagnosis and treatment of advanced gastrointestinal stromal tumor_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YIN Xiaonan ,  ZHANG Bo

Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, P.R.China;

Corresponding author：

ZHANG Bo, Email: zhangbo7310@126.com

Keywords：

gastrointestinal stromal tumor; imatinib; surgical treatment; comprehensive treatment

DOI：

10.7507/1007-9424.201701061

Video：

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Objective To summarize progress on diagnosis and treatment of advanced gastrointestinal stromal tumor (GIST). Method Through the retrieval of relevant literatures, the advances in the diagnosis and treatment of advanced GIST in recent years were reviewed. Results The diagnosis of advanced GIST mainly depends on imaging examination such as CT, MRI and endoscopy or endoscopic ultrasound. The diagnosis can be confirmed by needle biopsy for advanced GIST patients considering preoperative imatinib treatment. At present, the imatinib is the first-line therapy for patients with advanced GIST, followed by sunitinib and other novel targeted drugs. A multidisciplinary treatment strategy that included targeted therapeutic agents, combining with surgical resection, radiofrequency ablation and embolism chemotherapy have brought dramatic clinical benefit for advanced GIST. Conclusions GIST is easy to metastasis, clinicians should ensure early diagnosis and early treatment. In course of imatinib treatment, an individualized therapeutic regimen should be applied to treat advanced GIST based on specific situation of patients.

Citation： YINXiaonan, ZHANGBo. Advances of diagnosis and treatment of advanced gastrointestinal stromal tumor. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(2): 169-173. doi: 10.7507/1007-9424.201701061 Copy

1.	Sorour MA, Kassem MI, Ghazal, et al. Gastrointestinal stromal tumors (GIST) related emergencies. Int J Surg, 2014, 12(4): 269-280.
2.	Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era-a population-based study in western Sweden. Cancer, 2005, 103(4): 821-829.
3.	Kang TW, Kim SH, Jang KM, et al. Gastrointestinal stromal tumours: correlation of modified NIH risk stratification with diffusion-weighted MR imaging as an imaging biomarker. Eur J Radiol, 2015, 84(1): 33-40.
4.	Jenssen C, Alvarez-Sánchez MV, Napoléon B, et al. Diagnostic endoscopic ultrasonography: assessment of safety and prevention of complications. World J Gastroenterol, 2012, 18(34): 4659-4676.
5.	Tasdemir A, Soyuer I, Unal D, et al. Prognostic value of NF-κB, CD9, and VEGF in gastrointestinal stromal tumors. Contemp Oncol (Pozn), 2013, 17(6): 493-498.
6.	Langer C, Gunawan B, Schüler P, et al. Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumours. Br J Surg, 2003, 90(3): 332-339.
7.	Blay JY, Le Cesne A, Cassier PA, et al. Gastrointestinal stromal tumors (GIST): a rare entity, a tumor model for personalized therapy, and yet ten different molecular subtypes. Discov Med, 2012, 13(72): 357-367.
8.	Blanke CD, Rankin C, Demetri GD, et al. Phase Ⅲ randomized, intergroup trial assessing imatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase: S0033. J Clin Oncol, 2008, 26(4): 626-632.
9.	Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med, 2002, 347(7): 472-480.
10.	DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg, 2000, 231(1): 51-58.
11.	Rodriguez SA, Faigel DO. Endoscopic diagnosis of gastrointestinal stromal cell tumors. Curr Opin Gastroenterol, 2007, 23(5): 539-543.
12.	Palazzo L, Landi B, Cellier C, et al. Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumours. Gut, 2000, 46(1): 88-92.
13.	Hwang JH, Saunders MD, Rulyak SJ, et al. A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses. Gastrointest Endosc, 2005, 62(2): 202-208.
14.	Hong X, Choi H, Loyer EM, et al. Gastrointestinal stromal tumor: role of CT in diagnosis and in response evaluation and surveillance after treatment with imatinib. Radiographics, 2006, 26(2): 481-495.
15.	CSCO胃肠间质瘤专家委员会. 中国胃肠间质瘤诊断治疗共识(2013年版). 临床肿瘤学杂志, 2013, 18(11): 1025-1032.
16.	von Mehren M, Benjamin RS, Bui MM, et al. Soft tissue sarcoma, version 2. 2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw, 2012, 10(8): 951-960.
17.	Corless CL, Barnett CM, Heinrich MC. Gastrointestinal stromal tumours: origin and molecular oncology. Nat Rev Cancer, 2011, 11(12): 865-878.
18.	Novelli M, Rossi S, Rodriguez-Justo M, et al. DOG1 and CD117 are the antibodies of choice in the diagnosis of gastrointestinal stromal tumours. Histopathology, 2010, 57(2): 259-270.
19.	Romagnoli S, Graziani D, Bramerio M, et al. Immunohistochemical profile and c-kit mutations in gastrointestinal stromal tumors. Pathol Res Pract. 2005, 201(2): 71-81.
20.	Miettinen M, Sobin LH, Sarlomo-Rikala M. Immunohistochemical spectrum of GISTs at different sites and their differential diagnosis with a reference to CD117(KIT). Mod Pathol, 2000, 13(10): 1134-1142.
21.	Lasota J, Miettinen M. Clinical significance of oncogenic KIT and PDGFRA mutations in gastrointestinal stromal tumours. Histopathology, 2008, 53(3): 245-266.
22.	Zalcberg JR, Verweij J, Casali PG, et al. Outcome of patients with advanced gastro-intestinal stromal tumours crossing over to a daily imatinib dose of 800 mg after progression on 400 mg. Eur J Cancer, 2005, 41(12): 1751-1757.
23.	Heinrich MC, Corless CL, Demetri GD, et al. Kinase mutations and imatinib response in patients with metastatic gastrointestinal stromal tumor. J Clin Oncol, 2003, 21(23): 4342-4349.
24.	Li J, Shen L, Gong J, et al. The efficacy of dose escalation in Chinese patients with advanced GIST after 400 mg imatinib resistance: A prospective study. World J Gastroenterol, 2012, 18(7): 698-703.
25.	Demetri GD, Wang Y, Wehrle E, et al. Imatinib plasma levels are correlated with clinical benefit in patients with unresectable/metastatic gastrointestinal stromal tumors. J Clin Oncol, 2009, 27(19): 3141-3147.
26.	Bouchet S, Poulette S, Titier K, et al. Relationship between imatinib trough concentration and outcomes in the treatment of advanced gastrointestinal stromal tumours in a real-life setting. Eur J Cancer, 2016, 57: 31-38.
27.	Yin Y, Xiang J, Tang S, et al. A lower dosage of imatinib in patients with gastrointestinal stromal tumors with toxicity of the treatment. Medicine (Baltimore), 2016, 95(49): e5488.
28.	Blay JY, Le Cesne A, Ray-Coquard I, et al. Prospective multicentric randomized phase Ⅲ study of imatinib in patients with advanced gastrointestinal stromal tumors comparing interruption versus continuation of treatment beyond 1 year: the French Sarcoma Group. J Clin Oncol, 2007, 25(9): 1107-1113.
29.	Demetri GD, van Oosterom AT, Garrett CR, et al. Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: a randomised controlled trial. Lancet, 2006, 368(9544): 1329-1338.
30.	Demetri GD, Reichardt P, Kang YK, et al. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib (GRID): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet, 2013, 381(9863): 295-302.
31.	Benjamin RS, Casali PG. Adjuvant imatinib for GI stromal tumors: When and for how long? J Clin Oncol, 2016, 34(3): 215-218.
32.	Stiekema J, Kol S, Cats A, et al. Surgical treatment of gastrointestinal stromal tumors located in the stomach in the imatinib era. Am J Clin Oncol, 2015, 38(5): 502-507.
33.	Chang SC, Liao CH, Wang SY, et al. Feasibility and timing of cytoreduction surgery in advanced (metastatic or recurrent) gastrointestinal stromal tumors during the era of imatinib. Medicine (Baltimore), 2015, 94(24): e1014.
34.	Milhem M, Deutsch JM. Imatinib dosing in gastrointestinal stromal tumors (gists): when, how much, and how long? Curr Clin Pharmacol, 2015, 10(4): 311-320.
35.	Yeh CN, Chen TW, Tseng JH, et al. Surgical management in metastatic gastrointestinal stromal tumor (GIST) patients after imatinib mesylate treatment. J Surg Oncol, 2010, 102(6): 599-603.
36.	George S, Blay JY, Casali PG, et al. Clinical evaluation of continuous daily dosing of sunitinib malate in patients with advanced gastrointestinal stromal tumour after imatinib failure. Eur J Cancer, 2009, 45(11): 1959-1968.
37.	Kang YK, Ryu MH, Yoo C, et al. Resumption of imatinib to control metastatic or unresectable gastrointestinal stromal tumours after failure of imatinib and sunitinib (RIGHT): a randomised, placebo-controlled, phase 3 trial. Lancet Oncol, 2013, 14(12): 1175-1182.
38.	Blay JY, Shen L, Kang YK, et al. Nilotinib versus imatinib as first-line therapy for patients with unresectable or metastatic gastrointestinal stromal tumours (ENESTg1): a randomised phase 3 trial. Lancet Oncol, 2015, 16(5): 550-560.
39.	Antonescu CR, Besmer P, Guo T, et al. Acquired resistance to imatinib in gastrointestinal stromal tumor occurs through secondary gene mutation. Clin Cancer Res, 2005, 11(11): 4182-4190.
40.	Yoo C, Ryu MH, Nam BH, et al. Impact of imatinib rechallenge on health-related quality of life in patients with TKI-refractory gastrointestinal stromal tumours: Sub-analysis of the placebo-controlled, randomised phase Ⅲ trial (RIGHT). Eur J Cancer, 2016, 52: 201-208.
41.	Agulnik M, Giel JL. Understanding rechallenge and resistance in the tyrosine kinase inhibitor era: imatinib in gastrointestinal stromal tumor. Am J Clin Oncol, 2014, 37(4): 417-422.

1. Sorour MA, Kassem MI, Ghazal, et al. Gastrointestinal stromal tumors (GIST) related emergencies. Int J Surg, 2014, 12(4): 269-280.
2. Nilsson B, Bümming P, Meis-Kindblom JM, et al. Gastrointestinal stromal tumors: the incidence, prevalence, clinical course, and prognostication in the preimatinib mesylate era-a population-based study in western Sweden. Cancer, 2005, 103(4): 821-829.
3. Kang TW, Kim SH, Jang KM, et al. Gastrointestinal stromal tumours: correlation of modified NIH risk stratification with diffusion-weighted MR imaging as an imaging biomarker. Eur J Radiol, 2015, 84(1): 33-40.
4. Jenssen C, Alvarez-Sánchez MV, Napoléon B, et al. Diagnostic endoscopic ultrasonography: assessment of safety and prevention of complications. World J Gastroenterol, 2012, 18(34): 4659-4676.
5. Tasdemir A, Soyuer I, Unal D, et al. Prognostic value of NF-κB, CD9, and VEGF in gastrointestinal stromal tumors. Contemp Oncol (Pozn), 2013, 17(6): 493-498.
6. Langer C, Gunawan B, Schüler P, et al. Prognostic factors influencing surgical management and outcome of gastrointestinal stromal tumours. Br J Surg, 2003, 90(3): 332-339.
7. Blay JY, Le Cesne A, Cassier PA, et al. Gastrointestinal stromal tumors (GIST): a rare entity, a tumor model for personalized therapy, and yet ten different molecular subtypes. Discov Med, 2012, 13(72): 357-367.
8. Blanke CD, Rankin C, Demetri GD, et al. Phase Ⅲ randomized, intergroup trial assessing imatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase: S0033. J Clin Oncol, 2008, 26(4): 626-632.
9. Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med, 2002, 347(7): 472-480.
10. DeMatteo RP, Lewis JJ, Leung D, et al. Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival. Ann Surg, 2000, 231(1): 51-58.
11. Rodriguez SA, Faigel DO. Endoscopic diagnosis of gastrointestinal stromal cell tumors. Curr Opin Gastroenterol, 2007, 23(5): 539-543.
12. Palazzo L, Landi B, Cellier C, et al. Endosonographic features predictive of benign and malignant gastrointestinal stromal cell tumours. Gut, 2000, 46(1): 88-92.
13. Hwang JH, Saunders MD, Rulyak SJ, et al. A prospective study comparing endoscopy and EUS in the evaluation of GI subepithelial masses. Gastrointest Endosc, 2005, 62(2): 202-208.
14. Hong X, Choi H, Loyer EM, et al. Gastrointestinal stromal tumor: role of CT in diagnosis and in response evaluation and surveillance after treatment with imatinib. Radiographics, 2006, 26(2): 481-495.
15. CSCO胃肠间质瘤专家委员会. 中国胃肠间质瘤诊断治疗共识(2013年版). 临床肿瘤学杂志, 2013, 18(11): 1025-1032.
16. von Mehren M, Benjamin RS, Bui MM, et al. Soft tissue sarcoma, version 2. 2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw, 2012, 10(8): 951-960.
17. Corless CL, Barnett CM, Heinrich MC. Gastrointestinal stromal tumours: origin and molecular oncology. Nat Rev Cancer, 2011, 11(12): 865-878.
18. Novelli M, Rossi S, Rodriguez-Justo M, et al. DOG1 and CD117 are the antibodies of choice in the diagnosis of gastrointestinal stromal tumours. Histopathology, 2010, 57(2): 259-270.
19. Romagnoli S, Graziani D, Bramerio M, et al. Immunohistochemical profile and c-kit mutations in gastrointestinal stromal tumors. Pathol Res Pract. 2005, 201(2): 71-81.
20. Miettinen M, Sobin LH, Sarlomo-Rikala M. Immunohistochemical spectrum of GISTs at different sites and their differential diagnosis with a reference to CD117(KIT). Mod Pathol, 2000, 13(10): 1134-1142.
21. Lasota J, Miettinen M. Clinical significance of oncogenic KIT and PDGFRA mutations in gastrointestinal stromal tumours. Histopathology, 2008, 53(3): 245-266.
22. Zalcberg JR, Verweij J, Casali PG, et al. Outcome of patients with advanced gastro-intestinal stromal tumours crossing over to a daily imatinib dose of 800 mg after progression on 400 mg. Eur J Cancer, 2005, 41(12): 1751-1757.
23. Heinrich MC, Corless CL, Demetri GD, et al. Kinase mutations and imatinib response in patients with metastatic gastrointestinal stromal tumor. J Clin Oncol, 2003, 21(23): 4342-4349.
24. Li J, Shen L, Gong J, et al. The efficacy of dose escalation in Chinese patients with advanced GIST after 400 mg imatinib resistance: A prospective study. World J Gastroenterol, 2012, 18(7): 698-703.
25. Demetri GD, Wang Y, Wehrle E, et al. Imatinib plasma levels are correlated with clinical benefit in patients with unresectable/metastatic gastrointestinal stromal tumors. J Clin Oncol, 2009, 27(19): 3141-3147.
26. Bouchet S, Poulette S, Titier K, et al. Relationship between imatinib trough concentration and outcomes in the treatment of advanced gastrointestinal stromal tumours in a real-life setting. Eur J Cancer, 2016, 57: 31-38.
27. Yin Y, Xiang J, Tang S, et al. A lower dosage of imatinib in patients with gastrointestinal stromal tumors with toxicity of the treatment. Medicine (Baltimore), 2016, 95(49): e5488.
28. Blay JY, Le Cesne A, Ray-Coquard I, et al. Prospective multicentric randomized phase Ⅲ study of imatinib in patients with advanced gastrointestinal stromal tumors comparing interruption versus continuation of treatment beyond 1 year: the French Sarcoma Group. J Clin Oncol, 2007, 25(9): 1107-1113.
29. Demetri GD, van Oosterom AT, Garrett CR, et al. Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: a randomised controlled trial. Lancet, 2006, 368(9544): 1329-1338.
30. Demetri GD, Reichardt P, Kang YK, et al. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib (GRID): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet, 2013, 381(9863): 295-302.
31. Benjamin RS, Casali PG. Adjuvant imatinib for GI stromal tumors: When and for how long? J Clin Oncol, 2016, 34(3): 215-218.
32. Stiekema J, Kol S, Cats A, et al. Surgical treatment of gastrointestinal stromal tumors located in the stomach in the imatinib era. Am J Clin Oncol, 2015, 38(5): 502-507.
33. Chang SC, Liao CH, Wang SY, et al. Feasibility and timing of cytoreduction surgery in advanced (metastatic or recurrent) gastrointestinal stromal tumors during the era of imatinib. Medicine (Baltimore), 2015, 94(24): e1014.
34. Milhem M, Deutsch JM. Imatinib dosing in gastrointestinal stromal tumors (gists): when, how much, and how long? Curr Clin Pharmacol, 2015, 10(4): 311-320.
35. Yeh CN, Chen TW, Tseng JH, et al. Surgical management in metastatic gastrointestinal stromal tumor (GIST) patients after imatinib mesylate treatment. J Surg Oncol, 2010, 102(6): 599-603.
36. George S, Blay JY, Casali PG, et al. Clinical evaluation of continuous daily dosing of sunitinib malate in patients with advanced gastrointestinal stromal tumour after imatinib failure. Eur J Cancer, 2009, 45(11): 1959-1968.
37. Kang YK, Ryu MH, Yoo C, et al. Resumption of imatinib to control metastatic or unresectable gastrointestinal stromal tumours after failure of imatinib and sunitinib (RIGHT): a randomised, placebo-controlled, phase 3 trial. Lancet Oncol, 2013, 14(12): 1175-1182.
38. Blay JY, Shen L, Kang YK, et al. Nilotinib versus imatinib as first-line therapy for patients with unresectable or metastatic gastrointestinal stromal tumours (ENESTg1): a randomised phase 3 trial. Lancet Oncol, 2015, 16(5): 550-560.
39. Antonescu CR, Besmer P, Guo T, et al. Acquired resistance to imatinib in gastrointestinal stromal tumor occurs through secondary gene mutation. Clin Cancer Res, 2005, 11(11): 4182-4190.
40. Yoo C, Ryu MH, Nam BH, et al. Impact of imatinib rechallenge on health-related quality of life in patients with TKI-refractory gastrointestinal stromal tumours: Sub-analysis of the placebo-controlled, randomised phase Ⅲ trial (RIGHT). Eur J Cancer, 2016, 52: 201-208.
41. Agulnik M, Giel JL. Understanding rechallenge and resistance in the tyrosine kinase inhibitor era: imatinib in gastrointestinal stromal tumor. Am J Clin Oncol, 2014, 37(4): 417-422.

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Advances of diagnosis and treatment of advanced gastrointestinal stromal tumor

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