Treatment of gastrointestinal stromal tumor: focus on imatinib mesylate

Figures & data

Table 1 Proposed approach for defining risk of aggressive behavior in GISTs

	Size	Mitotic count
Very low risk	<2 cm	<5/50 HPF
Low risk	2–5 cm	<5/50 HPF
Intermediate risk	<5 cm	6–10/50 HPF
	5–10 cm	<5/50 HPF
High risk	>5 cm	>5/50 HPF
	>10 cm	Any mitotic rate
	Any size	>10/50 HPF

Reproduced with permission from Fletcher CD, Berman JJ, Corless C, et al. 2002. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol, 33:459–65. Copyright© 2002 Elsevier.

Abbreviation: HPF, high powered field.

Figure 1 KIT receptor and location and frequency of mutations.

Table 2 Prognostic factors for recurrence

Tumor size >5 cm

High grade

Tumor rupture

Small bowel origin

Table 3 Frequency of side effects (400 mg/day dose)

Symptom	Any grade %	Grade 3 or 4 %
Anemia	89	7
Oedema	71	2
Fatigue	68	6
Pleuritic pain	51	4
Nausea	49	3
Diarrhoea	48	2
Leucopenia	43	3
Granulocytopenia	41	7
Rash	27	2
Vomiting	26	3
Anorexia	26	2
Myalgia	24	0
Pruritus	16	1
Constipation	16	1

Derived from Verweij et al 2004.

Table 4 Neoadjuvant and adjuvant trials of imatinib in GIST

Tial	Title	Phase
RTOG-S0132	A phase II trial of neoadjuvant/adjuvant STI-571 for primary and recurrent operable malignant GIST expressing the KIT receptor tyrosine (CD117)	2
MDACC ID03-0023	A prospective, randomized, phase II study of preoperative plus postoperative imatinib mesylate (Gleevec^®, formerly STI-571) in patients with primary, recurrent, or metastatic resectable, Kit-expressing, gastrointestinal stromal tumor (GIST)	2
ACOSOG-Z9000	A phase II study of adjuvant STI571 (Gleevec^®) therapy in patients following completely resected high-risk primary gastrointestinal stromal tumor (GIST).	2
ACOSOG-Z9001	A phase III randomized double-blind study of adjuvant STI571 (Gleevec^®) versus placebo in patients following the resection of primary gastrointestinal stromal tumor (GIST).	3
EORTC 62024	Intermediate and high risk localized, completely resected, gastrointestinal stromal tumors (GIST) expressing KIT receptor: a controlled randomized trial on adjuvant imatinib mesylate (Glivec^®) versus no further therapy after complete surgery	3
SSGXVIII	Short (12 months) versus long (36 months) duration of adjuvant treatment with the tyrosine kinase inhibitor imatinib mesylate of operable GIST with a high risk for recurrence: a randomized phase III study	3
KRDI-TUM-GIST-CST1571-BDE43	Open-label trial of neoadjuvant imatinib mesylate (Glivec^®) in patients with locally advanced malignant gastrointestinal stromal tumors (GIST) expressing c-KIT or platelet-derived growth factor receptor-alpha	2
AMC-ONCGI-0501	Phase II study of imatinib mesylate as adjuvant treatment in high-relapse risk localized gastrointestinal stromal tumors with c-KIT mutation	2

Abbreviation: ACOSOG, American College of Surgeons Oncology Group; AMC, Asan Medical Center – University of Ulsan College of Medicine; EORTC, European Organization for Research and Treatment of Cancer; KRDI-TUM, Klinikum Rechts Der Isar – Technische Universitaet Muenchen; RTOG, Radiation Therapy Oncology Group; MDACC M. D. Anderson Cancer Center; SSG, Scandinavian Sarcoma Group.

FletcherCDBermanJJCorlessCDiagnosis of gastrointestinal stromal tumors: A consensus approachHum Pathol2002334596512094370

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VerweijJCasaliPGZalcbergJProgression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomised trialLancet2004364112734 see comment15451219

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