Gastrointestinal stromal tumor (GIST) recurrence following surgery: review of the clinical utility of imatinib treatment

Isabelle Deshaies¹, Jovenel Cherenfant¹, Niraj J Gusani¹, Yixing Jiang², Harold A Harvey², Eric T Kimchi¹, Jussuf T Kaifi¹, Kevin F Staveley-O’Carroll^1
1Program for Liver, Pancreas and Foregut Tumors, Department of Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA; ²Department of Medical Oncology, Penn State College of Medicine, Hershey, Pennsylvania, USA

Abstract: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Surgery with complete removal of the tumor is the primary treatment for resectable GIST and the only chance of cure. However, recurrence after surgery is common. The 2 main prognostic factors are the mitotic activity and the size of the tumor. Tumor rupture is also a risk factor for postoperative recurrence, and extra care should be taken while manipulating this soft and friable tumor. Imatinib mesylate (IM, Gleevec^®, Novartis, Basel, Switzerland) is a tyrosine kinase inhibitor and was first studied in the palliative setting for metastatic GIST patients in the year 2000. It is now the cornerstone of metastatic GIST treatment. IM also plays an important role as an adjuvant treatment for resectable GIST and has been shown to increase the recurrence-free survival in phase III studies. However, some points remain to be clarified. Notably, the ideal duration of adjuvant IM after surgery is still unclear. It is also difficult to determine the exact place of surgery in metastatic or recurrent GIST patients in the IM era. A multidisciplinary approach is, therefore, mandatory to offer GIST patients the best treatment available.

Keywords: Gleevec, adjuvant, neoadjuvant, metastasis, sunitinib