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Imatinib Exhibits Viability as Neoadjuvant Therapy for GIST
Investigators conducted a retrospective review of all patients diagnosed with GIST at Karolinska University Hospital in Stockholm, Sweden, between January 2000 and December 2019. Patients treated with neoadjuvant imatinib were selected and a descriptive analysis was performed in terms of response to treatment and survival outcomes.
Among the 455 patients, 84 received neoadjuvant treatment in combination with imatinib for a primary non-metastatic GIST. Patients who received neoadjuvant imatinib had tumors located throughout the gastrointestinal tract, notably adjacent to the gastroesophageal junction elsewhere in the stomach, small intestine, or rectum.
To note, the tumors were commonly large in size (mean 10.5 cm, range 2-27 cm) and located near vulnerable anatomical structures such as the gastroesophageal junction, pancreas or hepato-duodenal ligament, Treitz ligament or lower part of the rectum.
Size or anatomical location were the main indications for neoadjuvant imatinib, and patients experienced tumor shrinkage following neoadjuvant treatment (mean 7.6 cm, range 1,3-30 cm). Furthermore, 4 out of the 10 patients with tumors located near the gastroesophageal junction underwent gastrectomy.
A minor part of the patients with tumors in the small intestine, including duodenum, (3 out of 30) underwent more extensive surgery, whereas 7 out of the 12 patients with tumors in rectum had to undergo rectal amputation. Post surgery, 94% of the neoadjuvant treated tumors accomplished R0-resection. About 1/4 experienced local relapse or distant metastasis. -Alexis Hyams
