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Imatinib Highlights Gastrointestinal Stromal Tumors Task Force Report: Presented at NCCN

By Mark Fuerst

HOLLYWOOD, FL -- March 12, 2004 -- Revolutionary targeted therapy with imatinib (Gleevec) has led to revised treatment guidelines for a rare stomach cancer, gastrointestinal stromal tumors (GIST).

The National Comprehensive Cancer Network (NCCN) introduced its Gastrointestinal Stromal Tumors (GIST) Task Force Report, an expansion on the network's Sarcoma Clinical Practice Guidelines in Oncology. Though an uncommon cancer, GIST has been increasingly recognised after reports that imatinib, an oral cancer therapy that targets a molecular switch important to the tumor cells, could induce dramatic remissions and prolong survival for patients with advanced GIST.

"The clinical care of patients with GIST has changed radically in the past few years thanks to the rapid evolution of research translating into new, effective therapeutic strategies," said George D. Demetri, MD, chair, GIST Task Force, and director of the Center for Sarcoma and Bone Oncology at Harvard's Dana-Farber Cancer Institute. The GIST Task Force Report represents the work of expert physicians from several disciplines, including pathology, surgery, medical oncology, and radiology. Advances in pathologic diagnosis, imaging technology, and treatment modalities have merged to significantly change the way clinicians of multiple specialties interact to care for patients with GIST as a coordinated team.

Recommendations of the GIST Task Force Report were presented here March 11th at the NCCN 9th Annual Conference in Clinical Practice Guidelines and Outcomes Data in Oncology. The complete report will be published as a supplement to the May 2004 issue of the Journal of the National Comprehensive Cancer Network.

GIST is the most common form of gastrointestinal sarcoma. Recent data suggest that there are as many as 4,500 new cases of GIST per year in the United States. The Task Force Report notes that multiple clinical trials worldwide have consistently shown the efficacy of imatinib for GIST patients, with response rates for metastatic disease that typically exceed 65% and 1-year progression-free survival rates of about 70%.

The report calls for an initial work-up that includes an abdominal/pelvic computed tomography (CT) scan with contrast, said Ronald DeMatteo, MD, an assistant member at Memorial Sloan-Kettering Cancer Center. "Surgery is still the best approach for easily resectable GIST," said Dr. DeMatteo. A post-operative pathology assessment is essential to confirm the diagnosis after removal of any suspected GIST, the report notes.

If the GIST is unresectable or metastatic, therapy with imatinib 400 mg daily is recommended. Surgical debulking should be considered for any patient with progressing disease. Positron emission tomography (PET) scans show early metabolic changes and can help predict patient response to imatinib; they are recommended at baseline and after 2-4 weeks of therapy.

Recurrent disease carries the same prognosis as metastatic disease and should also be treated with imatinib. "Management of metastatic GIST requires lifelong therapy," said Dr. Demetri. Clinical trials show that the overall survival of GIST patients receiving imatinib is equally good for those who have stable disease and for those who respond well, so "disease stability is a good marker for success," he said.

The task force report recommends that widespread disease should be treated with imatinib in increasing doses, if necessary, and followed with regular assessments by CT and PET scans.


Title: NCCN Task Force Report: Gastrointestinal Stromal Tumor (GIST).

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