Back to Search
Start Over
Surgical Management of Metastatic Gastrointestinal Stromal Tumors
- Source :
- Current Treatment Options in Oncology. 22
- Publication Year :
- 2021
- Publisher :
- Springer Science and Business Media LLC, 2021.
-
Abstract
- Treatment with the tyrosine kinase inhibitor (TKI), imatinib is the standard first-line treatment for metastatic gastrointestinal stromal tumors (GISTs). Unfortunately, acquired c-kit mutations cause secondary resistance to imatinib in a median of 18–24 months. Sunitinib and regorafenib are multi-kinase inhibitors that can be used as second-line or third-line therapy in imatinib-resistant or -intolerant GISTs, respectively. Ripretinib (a switch-control tyrosine kinase inhibitor) has recently been approved for fourth-line treatment in metastatic GIST. The TKI avapritinib has been approved for metastatic GIST harboring the imatinib-resistant PDGFRA exon 18 mutation. Although TKI therapies have revolutionized the treatment of metastatic GISTs, they cannot cure metastatic GISTs. Therefore, cytoreductive surgery is of considerable interest and has been accordingly investigated. Retrospective non-randomized studies demonstrated the feasibility and safety of continuous TKI therapy and surgical resection. Most studies demonstrate response to TKI therapy, completeness of resection, extent of disease, and surgical complexity as predictors of outcomes. Most TKIs can be stopped shortly before surgery and restarted shortly after. There is no known survival benefit from debulking operations or R2 resections and this should not be considered. However, debulking/palliative surgery may be necessary for patients with complications of hemorrhage, pain, or intestinal obstruction. SDH-deficient GISTs have an indolent natural history despite metastatic disease and may be another uncommon subgroup that would benefit from surgical debulking (R2 resection). At the time of operation, care should be taken to avoid tumor rupture. After surgical resection, patients should resume tyrosine kinase inhibitor (TKI) therapy as soon as possible and be monitored for disease progression. In all patients with metastatic GIST, the decision to pursue metastasectomy for GIST should be made in a multidisciplinary setting and be individualized according to patient age, comorbidities, functional status, symptoms, mutation status, extent of disease, completeness of resection, TKI response, and goals of the patient.
- Subjects :
- 0301 basic medicine
Oncology
medicine.medical_specialty
medicine.drug_class
Disease
Tyrosine-kinase inhibitor
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Internal medicine
Regorafenib
medicine
Pharmacology (medical)
neoplasms
GiST
Sunitinib
business.industry
Imatinib
Debulking
digestive system diseases
030104 developmental biology
chemistry
030220 oncology & carcinogenesis
Metastasectomy
business
medicine.drug
Subjects
Details
- ISSN :
- 15346277 and 15272729
- Volume :
- 22
- Database :
- OpenAIRE
- Journal :
- Current Treatment Options in Oncology
- Accession number :
- edsair.doi...........cc993a9f68edc96f256fb2c8ed2fd6fd