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Adjuvant treatment of GIST: patient selection and treatment strategies

Nature Reviews Clinical Oncology volume 9, pages 351–358 (2012)Cite this article

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Abstract

Tyrosine kinase inhibitors that target the key molecular drivers of gastrointestinal stromal tumour (GIST) are effective treatments of advanced-stage GIST. Yet, most of these patients succumb to the disease. Approximately 60% of patients with GIST are cured by surgery, and these individuals can be identified by risk stratification schemes based on tumour size, mitosis count and site, and assessment of rupture. Two large randomized trials have evaluated imatinib as adjuvant treatment for operable, KIT-positive GIST; adjuvant imatinib substantially improved time to recurrence. One of these trials reported that 3 years of adjuvant imatinib improves overall survival of patients who have a high estimated risk for recurrence of GIST compared with 1 year of imatinib. The optimal adjuvant strategy remains unknown and some patients might benefit from longer than 3 years of imatinib treatment. However, a strategy that involves GIST risk assessment following surgery using a validated scheme, administration of adjuvant imatinib for 3 years, patient monitoring during and after completion of imatinib to detect recurrence early, and reinstitution of imatinib if GIST recurs is a reasonable choice for care of patients with high-risk GIST.

Key Points

  • The currently available risk stratification schemes are reasonably accurate at predicting the risk of gastrointestinal stromal tumour (GIST) recurrence and helpful for identifying patients who are likely to be cured by surgery

  • Adjuvant imatinib improves recurrence-free survival of patients who have undergone surgery for GIST and who have a substantial risk of recurrence

  • In a randomized phase III trial, adjuvant imatinib administered for 3 years after surgery improved recurrence-free survival and overall survival compared with 1 year of administration

  • An adjuvant strategy that involves follow up with imaging and early reinstitution of tyrosine kinase inhibitor therapy if GIST recurs may be important for achieving optimal survival outcomes

  • Special subgroups, such as GISTs with a gene mutation that renders the tumour insensitive to imatinib, need to be identified when patients are considered for systemic adjuvant therapy

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Figure 1: The stem cell hypothesis.

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  1. Department of Oncology, Helsinki University Central Hospital, Haartmaninkatu 4, POB 180, Helsinki, FIN-00029, Finland

    Heikki Joensuu

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The author declares that he acts as a consultant for and receives honoraria and grant support from Novartis.

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Supplementary Table 1

Cohort studies addressing adjuvant imatinib and studies addressing preoperative imatinib for GIST (DOC 64 kb)

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Joensuu, H. Adjuvant treatment of GIST: patient selection and treatment strategies. Nat Rev Clin Oncol 9, 351–358 (2012). https://doi.org/10.1038/nrclinonc.2012.74

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