Surgery for Residual GIST May Improve Outcomes
According to a study published in the Journal of Surgical Oncology, patients with initially inoperable and/or metastatic gastrointestinal stromal tumors (GIST) that respond to treatment with Gleevec® (imatinib mesylate) may benefit from surgical removal of remaining cancer.
GIST is a rare type of cancer that originates in the wall of the gastrointestinal track. The American Cancer Society estimates that only approximately 5,000 individuals are diagnosed annually with GIST in the U.S. GIST is thought to originate in the “pacemaker” cells of the digestive system, which are responsible for the movement of food or nutrients through the system.
In patients with inoperable and/or metastatic GIST, treatment with the targeted agent Gleevec has produced dramatic results. Researchers continue, however, to evaluate new approaches to treatment.
For patients who experience a reduction in cancer following treatment with Gleevec, surgical removal of the remaining cancer may further improve outcomes. To evaluate the potential uses of surgery during Gleevec therapy in patients with initially inoperable and/or metastatic GIST, researchers in Poland assessed 141 patients. All patients had been treated with Gleevec.
Surgery was performed in 32 of the 141 patients. Twenty-four patients had surgery after a complete or partial response to Gleevec and lack of further response (Group 1), and eight patients had surgery for salvage therapy (treatment of cancer that had progressed following initially successful Gleevec treatment [Group 2]). Patients were followed for a median of 12 months.
- The first five patients in Group 1 did not continue treatment with Gleevec after surgery, and four of the five patients had a cancer recurrence.
- The next 19 patients in Group 1 did continue Gleevec after surgery, and only one experienced a cancer recurrence.
- In Group 2, five of the eight patients experienced cancer progression in spite of continuing treatment with Gleevec.
The researchers conclude that in patients with initially inoperable or metastatic GIST that has responded to treatment with Gleevec, surgical removal of remaining cancer may produce a complete remission in some patients. The researchers note, however, that Gleevec must be continued after surgery. It is still uncertain whether this approach will improve survival.
Reference: Rutkowski P, Nowecki Z, Nyckowski P et al. Surgical Treatment of Patients with Initially Inoperable and/or Metastatic Gastrointestinal Stromal Tumors (GIST) During Therapy with Imatinib Mesylate. Journal of Surgical Oncology. 2006;93:304-311.