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New fronts in the adjuvant treatment of GIST

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Abstract

Purpose

To review the prognostic factors and stratification systems used to determine the need for adjuvant therapy in the treatment of gastrointestinal stromal tumors (GIST), and to review recent clinical advances in investigation of the efficacy and safety of adjuvant imatinib mesylate treatment.

Methods

Recent data from clinical trials of various durations of adjuvant imatinib in GIST are reviewed, with emphasis on key results from the Phase III American College of Surgeons Oncology Group (ACOSOG) Z9001 trial and the Scandinavian Sarcoma Group XVIII/Arbeitsgemeinschaft Internistische Onkologie (SSGXVIII/AIO) trial.

Results

Complete surgical resection remains the standard of treatment for localized GISTs; however, disease recurrence occurs in up to 50 % of patients who undergo complete resection. The ACOSOG Z9001 trial established that 1 year of adjuvant imatinib reduces the risk of recurrence in patients with resected GIST. The SSGXVIII/AIO trial further demonstrated that 3-year adjuvant imatinib improves both recurrence-free survival and overall survival compared with 1-year therapy in patients at high risk of recurrence after surgery. Considering risk factors associated with tumor recurrence is essential for identifying the patients who are most likely to benefit from adjuvant imatinib.

Conclusions

Although the optimal duration of adjuvant therapy remains to be determined, results from these pivotal trials provide firm evidence that adjuvant imatinib improves recurrence-free survival and improved overall survival of patients in the SSGXVIII/AIO trial. Ongoing studies may shed further light on the benefits and harms of adjuvant therapy, as well as the most appropriate patient candidates for adjuvant imatinib treatment.

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Acknowledgments

Financial support for medical editorial assistance was provided by Novartis Pharmaceuticals. We thank Jared Wels, PhD, for his medical editorial assistance with this manuscript.

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Authors and Affiliations

  1. Department of Hematology, Oncology and Palliative Medicine, HELIOS Klinikum Bad Saarow, Pieskower Strasse 33, 15526, Bad Saarow, Germany

    Peter Reichardt

  2. Department of Oncology, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 180, Helsinki, Finland

    Heikki Joensuu

  3. Department of Medical Oncology, Centre Léon-Bérard, 28 rue Laënnec, 69008, Lyon, France

    Jean-Yves Blay

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  1. Peter Reichardt
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  2. Heikki Joensuu
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  3. Jean-Yves Blay
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Correspondence to Peter Reichardt.

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Reichardt, P., Joensuu, H. & Blay, JY. New fronts in the adjuvant treatment of GIST. Cancer Chemother Pharmacol 72, 715–723 (2013). https://doi.org/10.1007/s00280-013-2248-0

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