my personal edition > gist > news


  E-Mail this DGReview to a colleague

DGReview

Imatinib Mesylate May Be Effective in Treating Advanced Gastrointestinal Stromal Tumours

Good response and improvements in performance are seen after imatinib treatment in patients with advanced gastrointestinal stromal tumours, according to observations in 2 patients whose disease was not amenable to surgery, chemotherapy or radiation therapy.

Less than 5% of patients with advanced gastrointestinal tumours respond to conventional chemotherapy. Moreover, the median duration of survival for these patients is 20 months. New therapies are needed for this treatment group.

Imatinib mesylate is a selective inhibitor of some protein kinases, including the kit-receptor tyrosine kinase which is expressed in all gastrointestinal stromal tumours. This targeted inhibitor has shown activity against advanced gastrointestinal stromal tumours and has a mild toxicity profile. Imatinib is therefore a promising treatment for these patients.

Syed Hasan, MD, and colleagues at Howard University Hospital, Washington, DC, United States, evaluated the use of imatinib mesylate in 2 men with histologically-confirmed, unresectable and metastatic gastrointestinal stromal tumours that expressed CD117.

One patient was a 49-year old African-American man with a 22 x 24 cm gastric mass and a hepatic lesion that were identified by computed tomography (CT) scan of the abdomen. CT guided biopsy indicated gastrointestinal stromal tumour. The patient improved after subtotal gastrectomy, splenectomy, pancreatectomy and small bowel resection followed by 1500 cGy radiation therapy to the liver.

However, the patient presented again 6 months later with massive hepatomegaly. CT scan identified a 14 x 12 cm hepatic mass that disappeared after 90 days of imatinib (400 mg/day) treatment.

The second patient was a 70-year old Nigerian man with a history of chronic obstructive pulmonary disease and cardiomyopathy. The patient presented with a large bleeding tumour, liver metastases, congestive heart failure and ascites. Biopsy performed during upper endoscopy showed gastrointestinal stromal tumour.

Imatinib treatment for 1 month improved symptoms, and repeat CT scans indicated a more than 90% improvement in liver metastases.

Both patients showed improvements in World Health Organisation Performance Status after imatinib therapy from 4 to 2. Furthermore, imatinib was well tolerated in both patients, with no signs of myelotoxicity. However, mild to moderate oedema, diarrhoea and fatigue were common.

The authors conclude that "imatinib mesylate induced a sustained response in both patients with advanced unresectable or metastatic gastrointestinal stromal tumours."

"Further studies with larger number of patients with advanced gastrointestinal stromal tumour should be conducted to better assess the response of this invariably fatal tumour to imatinib mesylate," they add.

J Natl Med Assoc 2003 Dec;95:12:1208-10. "Advanced gastrointestinal stromal tumors successfully treated with imatinib mesylate: a report of two cases"

E-Mail this DGReview to a colleague

To print, use this version