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Neoadjuvant Treatment of
Gastrointestinal Stromal Tumors (GIST)
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Surgical resection is the primary intervention of treatment for GISTs when the tumor is resectable with minimal surgical morbidity. However, when the size and/or location of the tumor makes it inoperable, increases likely morbidity, or renders the tumor only partially resectable, NCCN treatment guidelines call for neoadjuvant treatment with a TKI prior to surgery.1

Pretreatment with a KIT TKI has been shown to downstage GISTs and/or their metastases and render them resectable in many cases.2-4

What is the optimal duration of neoadjuvant
TKI treatment?

The duration of TKI treatment prior to surgical resection is generally based on the radiographic response to treatment.

  • Patients who are responding to treatment should be treated until maximal tumor reduction is achieved, which may take 3 to 6 months1
  • In patients with unresectable/metastatic GIST who are not responding to treatment, a dosage increase or change in TKI may be considered1,4
  • Early surgical intervention is recommended, whenever possible, in patients who have stable disease, as progressive disease is associated with a worse outcome4,5 and tumors may rapidly become unresectable1,4
Case study: neoadjuvant treatment of unresectable metastatic GIST2
Before
Treatment
3 Weeks
12 Weeks
Postsurgery

A 56-year old man was diagnosed with a large (35 cm) GIST, filling most of the lower abdominal cavity, as well as mesenteric and liver metastases (A, D). Both the primary tumor and metastases were considered unresectable, and TKI treatment was initiated.

PET before neoadjuvant TKI treatment

PET before neoadjuvant TKI treatment

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The red and yellow hues indicate
the increased updated of the tracer
flurodeoxyglucose

CT scan before neoadjuvant TKI treatment

CT scan before neoadjuvant TKI treatment

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Reprinted permission from Macmillan Publishers Ltd: Br J Cancer.
2003;89(3):460-464, copyright 2003. Bumming, Andersson, Meis-Kindblom, et al.2

 

  1. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Soft tissue sarcoma. v.2.2008.
    http://www.nccn.org/professionals  /physician_gls/PDF/sarcoma.pdf. Accessed November 24, 2008.

  2. Bumming P, Andersson J, Meis-Kindblom JM, et al. Neoadjuvant, adjuvant and palliative treatment of gastrointestinal stromal tumours (GIST) with imatinib: a centre-based study of 17 patients. Br J Cancer. 2003;89(3):460-464.

  3. Radkani P, Gheris MM, Paramo JC, Mesko TW. A multidisciplinary approach for the treatment of GIST liver metastasis. World J Surg Oncol. 2008;6:46.

  4. Andtbacka RHI, Ng CS, Scaife CL, et al. Surgical resection of gastrointestinal stromal tumors after treatment with imatinib. Ann Surg Oncol. 2007;14(1):14-24.

  5. Gronchi A, Fiore M, Miselli F, et al. Surgery of residual disease following molecular-targeted therapy with imatinib mesylate in advanced/metastatic GIST. Ann Surg. 2007;245(3):341-346.

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