Journal Review in Surgical Oncology: Gastrointestinal Stromal Tumors (GISTs)
Mar 4, 2024
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Explore the debate over one versus three years of adjuvant imatinib treatment for gastrointestinal stromal tumors, highlighting improved recurrence-free and overall survival with longer therapy. Dive into the impact of targeted therapies on GIST care, discussing variations in therapy durations and implications on survival rates. Compare US and European healthcare systems in managing GISTs, and gain insights on factors influencing recurrence risk, treatment response, and therapy resistance in GIST patients.
Tailoring GIST treatment based on tumor mutations, particularly exon 11, is crucial for optimal outcomes.
Deep dives
Revolutionizing the Care of Gastrointestinal Stromal Tumors with Molecularly Targeted Therapies
The podcast delves into the transformation of managing patients with gastrointestinal stromal tumors (GISTs) through molecularly targeted therapies such as imatinib. Before these therapies, patients with metastatic or high-risk GISTs faced dismal outcomes. Imatinib, a game changer in GIST treatment, significantly improved recurrence-free survival for high-risk patients, paving the way for a shift in therapeutic approaches.
Comparing One vs. Three Years of Adjuvant Imatinib Treatment for GIST
A randomized trial, highlighted in the podcast, compared one year versus three years of adjuvant imatinib therapy for operable GIST patients. The study, focusing on recurrence-free survival as the primary endpoint, demonstrated that a three-year duration of imatinib provided superior outcomes with statistically significant 5-year recurrence-free survival rates of 65% versus 47%. Additionally, longer-term therapy was well-tolerated with mild side effects reported.
Considerations and Implications for Clinical Practice
The podcast discussion sheds light on practical clinical implications drawn from the trial, emphasizing the importance of understanding tumor mutations in tailoring treatment decisions for GIST. Notably, patients with exon 11 mutations derived substantial benefits from extended imatinib therapy. The trial's findings underscore the need for individualized approaches in managing GIST, considering factors such as tumor subtype and duration of imatinib therapy for optimal patient outcomes.
Join the Behind the Knife Surgical Oncology Team as we discuss “One versus Three Years of Adjuvant Imatinib for Operable Gastrointestinal Stromal Tumor: A Randomized Trial,” the randomized trial guiding duration of imatinib treatment for gastrointestinal stromal tumors (GIST).
Hosts:
- Timothy Vreeland, MD, FACS (@vreelant) is an Assistant Professor of Surgery at the Uniformed Services University of the Health Sciences and Surgical Oncologist at Brooke Army Medical Center.
- Daniel Nelson, DO, FACS (@usarmydoc24) is Surgical Oncologist and current HPB fellow at MD Anderson.
- Connor Chick, MD (@connor_chick) is a Surgical Oncology fellow at Ohio State University.
- Lexy (Alexandra) Adams, MD, MPH (@lexyadams16) is a PGY-6 General Surgery resident at Brooke Army Medical Center.
- Beth (Elizabeth) Carpenter, MD (@elizcarpenter16) is a PGY-5 General Surgery resident at Brooke Army Medical Center.
Learning Objectives:
In this episode, we discuss the article “One versus Three Years of Adjuvant Imatinib for Operable Gastrointestinal Stromal Tumor: A Randomized Trial” published in JAMA in 2012. This study demonstrated that 3 years of imatinib led to improved recurrence-free and overall survival compared to 1 year.