Gastrointestinal stromal tumour treated with neoadjuvant imatinib (original) (raw)
Related papers
2012
Background: Gastrointestinal stromal tumors (GIST) are mesenchymal tumors and account for 3% of all gastrointestinal malignancies. They are unpredictable, rare, enigmatic and display aggressive behavior 1. They express tyrosine kinase (KIT) and commonly involve small gut and stomach (rarely esophagus, mesentery and colon). A series of 11 cases of GIST managed in a teaching hospital attached to a medical college over 4 years is presented. Methods: Medical records of the 11 cases of GIST managed during January 2013 through December 2016 were reviewed for patient demographics, clinical presentation, investigation, sites, treatment, histology, immunohistochemistry and Imatinib therapy. Follow up for recurrence over the period ranging from 6 months to 4 years was done. Results: GIST was common in men. Age ranged 28 to 75 years. Sites involved were-small bowel in 5, stomach in 2, mesentery in 2, rectum and greater omentum 1 each. Symptoms ranged from abdominal pain, mass, upper /lower gastrointestinal bleeding, small bowel obstruction. Surgery was the mainstay of the treatment. All were positive for tyrosine kinase. One case was non resectable and another showed metastasis to the mesenteric lymph nodes, which is uncommon. All received Imatinib post operatively. Recurrence was seen in one patient with small bowel GIST at 2 years. Conclusions: GIST are uncommon with varied presentations and may be aggressive and can recur. GIST tumors elaborate tyrosine kinase, hence KIT receptor inhibitor Imatinib was useful in all, nonresectable & recurrent tumors. Tyrosine kinase inhibitor has thus drastically changed the diagnosis and management of these tumors.
British journal of cancer, 2003
Malignant gastrointestinal stromal tumours (GIST) have a poor prognosis. Since these tumours are resistant to conventional radiation and chemotherapy, surgery has been the mainstay of treatment. However, surgery is usually inadequate for the treatment of malignant GIST. Imatinib, a KIT tyrosine kinase inhibitor, has recently been found to have a dramatic antitumour effect on GIST. In this centre-based study of 17 consecutive patients with high-risk or overtly malignant GIST, imatinib was used in three different settings - palliatively, adjuvantly, and neoadjuvantly. The treatment was found to be safe and particularly effective in tumours with activating mutations of exon 11 of the KIT gene. Clinical response to imatinib treatment correlated morphologically to tumour necrosis, hyalinisation, and reduced proliferative activity. The value of neoadjuvant imatinib treatment was illustrated in one case.
European Journal of Surgical Oncology (EJSO), 2007
Aims: To review the clinical features of gastrointestinal stromal tumours (GISTs), the role of surgery and its principles and molecular targeted therapies. Methods: A Medline-based literature search on relevant topics was performed in PubMed for key articles concerning the clinical features, biology and the novel strategies in the management, whether surgical and/or pharmaceutical, of gastrointestinal stromal tumours. Some information was obtained from Proceedings of the American Society for Clinical Oncology published recently. Results: Surgical resection, the first-line intervention for operable GISTs, was historically the only effective treatment. For residual, metastatic and/or inoperable disease, treatment options remain under intense and continuous scrutiny. However, their molecular genetics, i.e. the mutations of the genes coding for KIT or platelet-derived growth factor receptor a, two receptor tyrosine kinases, have been targeted for therapeutic intervention by imatinib mesylateda tyrosine kinase inhibitor. Conclusion: Treatment of GISTs with imatinib has led to dramatic improvements in progression-free and overall survival, thereby rendering its use in the preoperative and postoperative treatment under intense investigation. New investigational agents are being developed and participation in promising clinical trials remains a standard of care.
World journal of gastroenterology : WJG, 2006
Most gastrointestinal stromal tumors (GISTs) express constitutively activated mutant isoforms of kit kinase or platelet-derived growth factor receptor alpha (PDGFRA), which are potential therapeutic targets for imatinib mesylate (Glivec). Partial response occurred in almost two thirds of GIST patients treated with Glivec. However, complete response (CR) after Glivec therapy was sporadically reported. Here we illustrated advanced GIST patients with CR after Glivec treatment. Between January 2001 and June 2005, 42 advanced GIST patients were treated with Glivec. Patients were administered 400 mg of Glivec in 100-mg capsules, taken orally daily with food. The response of the tumor to Glivec was evaluated after one month, three months, and every three months thereafter or whenever medical need was indicated. Each tumor of patients was investigated for mutations of kit or PDGFRA. The median follow-up time of the 42 advanced GIST patients treated with Glivec was 16.9 months (range, 1.0-47...
Evaluating and Reporting Gastrointestinal Stromal Tumors after Imatinib Mesylate Treatment
The Open Pathology Journal, 2009
Malignant and advanced gastrointestinal stromal tumors (GIST) are currently treated with imatinib mesylate, an inhibitor of KIT and PDGFRA receptor tyrosine kinase. Pathologic evaluation of residual disease is the gold standard in these cases, as clinical and radiologic assessments of treatment response do not always correlate with the pathologic response. Phenotypic and genotypic changes may also occur which may have an impact on treatment decisions. This review will focus on the role of the pathologist in ordering appropriate testing for the primary tumor, the morphologic, phenotypic and genotypic changes seen following imatinib therapy in cases of advanced GIST, and essential components of the pathology reports.
Management of gastrointestinal stromal tumours in the Imatinib era: a surgeon's perspective
World Journal of Surgical Oncology, 2008
Background: Surgical resection has remained the mainstay of treatment of GIST with a 5-yearsurvival of 28-35%. Tyrosine kinase inhibitor (Imatinib) has revolutionised the treatment of these tumours. The current research is directed towards expanding the role of this drug in the treatment of GIST. We present our experience of managing GIST in this institute.
Management of malignant gastrointestinal stromal tumours
The Lancet Oncology, 2002
Gastrointestinal stromal tumours (GISTs) are the most common form of mesenchymal tumour of the gastrointestinal tract. Clinically, they range from small indolent tumours curable with surgery alone to aggressive cancers. Making a distinction between an indolent and a malignant GIST is unreliable with conventional histopathological techniques. The presence of metastases at the time of diagnosis confirms malignancy, but all GISTs should be regarded as having malignant potential. GISTs characteristically express the KIT protein, a transmembrane tyrosine kinase receptor for stem-cell factor.