According to an article recently published in the Journal of Clinical Oncology, the surgical removal of remaining cancer may improve survival for patients with gastrointestinal stromal tumors who achieve anticancer responses to systemic therapy. However, patients whose cancer progresses on systemic therapy do not appear to benefit from surgery.
Gastrointestinal stromal tumors (GIST) are a rare type of cancer that originates in the wall of the gastrointestinal track. The American Cancer Society estimates that approximately only 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 also continue to evaluate other new approaches to treatment.
Results from previous studies have indicated that for patients with GIST who experience a reduction in cancer following treatment with Gleevec, surgical removal of the remaining cancer may further improve outcomes.
Researchers affiliated with Harvard Medical School recently conducted a study to further evaluate the effects of surgery in patients with GIST who had received prior systemic therapy, mainly with Gleevec. This study included 69 patients with a follow-up of nearly 15 months.
- 78% of patients whose cancer was stabilized prior to surgery had no remaining cancer following surgery, compared with only 25% of patients who had limited cancer progression prior to surgery and only 7% of patients whose cancer was generally progressing prior to surgery.
- At one year, progression-free survival was 80% for patients for patients whose cancer was stabilized prior to surgery, compared with only 33% for those with limited progression prior to surgery and 0% for patients with generalized progression prior to surgery.
- At one year, overall survival was 95% for patients whose cancer was stabilized prior to surgery, 86% for those with limited cancer progression prior to surgery and 0% for patients with generalized progression prior to surgery.
The researchers concluded that the ability to slow or halt cancer progression prior to surgery appears to play a major role in outcomes following surgery in patients with GIST. The authors suggest that patients whose cancer has not responded to systemic therapy do not appear to benefit from surgery.
Clinical trials directly comparing patients who undergo surgery for GIST to those who do not undergo surgery are warranted to truly determine the possible benefits of surgery.
Reference: Raut C, Posner M, Desai J, et al. Surgical Management of Advanced Gastrointestinal Stromal Tumors After Treatment With Targeted Systemic Therapy Using Kinase Inhibitors. Journal of Clinical Oncology. 2006; 24: 2325-2331.