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DGDispatch
Preoperative Imatinib Prolongs Disease-Free Survival in Locally Advanced Primary Gastrointestinal Stromal Tumors: Presented at SSO
By Michael Smith
ATLANTA, GA -- March 7, 2005 -- Preoperative treatment with imatinib extends disease-free survival in patients with locally advanced primary gastrointestinal stromal tumors (GIST), but is less promising in patients with recurrent or metastatic disease, U.S. researchers say.
"Neoadjuvant imatinib should be considered [as a treatment] for locally advanced primary GIST," said Robert H. Andtbacka, MD, Fellow, Department of Surgical Oncology, M.D. Anderson Cancer Center, Houston, Texas, United States.
In patients with recurring or metastatic disease whose tumor is responding to imatinib, surgery should be considered earlier rather than later, because a complete resection improves disease-free survival rates, he said here on March 5th at the Society of Surgical Oncology 58th Annual Cancer Symposium.
Dr. Andtbacka reported on 46 patients who were given preoperative imatinib; 11 had locally advanced GIST and 35 had recurring or metastatic disease.
His research team previously showed that it is feasible to operate on patients with recurring or metastatic GIST after pre-operative imatinib therapy, but "the long-term outcome is not known."
In the 11 cases of locally advanced disease that he presented here, the outcome was excellent, he said. Surgeons were able to perform a complete resection in all 11 patients -- one had a complete pathological response, 9 had a partial pathological response, and one had no response.
After a median postoperative follow-up of 19.5 months, "all patients are alive," he said. Moreover, 10 of the 11 are free of disease, he said, so it is not possible to establish a median disease-free survival time.
The picture is less clear in the 35 patients with recurring or metastatic disease, Dr. Andtbacka said; the key factor is the ability to perform a complete resection.
Eleven of the 35 were given a complete resection, he said; six have since had recurrences and the median disease-free survival is 24.7 months. In the remaining 24 patients, who underwent an incomplete resection, five have died and 19 are alive with disease. There was no period of disease-free survival.
The factor that seemed to predict whether a patient could get a complete resection or not was partial response to imatinib, as determined by radiological examination. There were no complete radiological responses in this group.
Ten of the 11 recurrent/metastatic patients who got a complete resection had a partial radiological response, while 23 of the remaining 24 had progressive disease confirmed by imaging.
The bottom line, Dr. Andtbacka said, is that for patients with locally advanced primary GIST, neoadjuvant imatinib sharply prolongs survival. But for those with recurrent or metastatic disease who respond to the drug, the key is to operate as quickly as possible so as to allow a complete resection.
[Presentation title: Surgical Resection of Gastrointestinal Stromal Tumors After Treatment with Imatinib. Abstract 89]
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