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Gastrointestinal stromal tumors (GISTs)
Mandeep S Saund1, George D Demetri, Stanley W Ashley
1Department of Surgery, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
Current Opinion in Gastroenterology
|February 11, 2005
Summary
Gastrointestinal stromal tumors (GISTs) are driven by KIT protein activation. Imatinib mesylate offers targeted therapy, with ongoing research into prognostic factors and expanded treatment roles for GISTs.
Area of Science:
- Oncology
- Molecular Biology
- Gastroenterology
Background:
- Gastrointestinal stromal tumors (GISTs) are characterized by the aberrant activation of the KIT protein tyrosine kinase.
- KIT kinase activity is crucial for tumor cell survival, development, and proliferation.
- Imatinib mesylate represents a novel molecularly targeted therapy for GISTs by inhibiting KIT kinase activity.
Purpose of the Study:
- To review recent advancements in the understanding and treatment of GISTs.
- To summarize findings on imaging, prognostic factors, molecular events, and systemic therapy for GISTs.
- To highlight the evolving role of imatinib mesylate in GIST management.
Main Methods:
- Review of recent publications on GISTs.
- Analysis of studies on imaging modalities (endoscopic ultrasound, CT, PET).
- Evaluation of prognostic markers (mitoses, Ki-67, p53, p16) and KIT mutational analysis.
Main Results:
- Endoscopic ultrasound with fine-needle aspiration aids in differentiating GISTs.
- CT and PET imaging provide clearer insights into GIST identification, staging, and treatment response.
- Tumor size and mitoses remain key prognostic indicators, with emerging data on Ki-67, p53, and p16.
- KIT mutational analysis is critical for prognosis and predicting therapy resistance.
- Imatinib mesylate demonstrates confirmed benefits, with interest in adjuvant settings and combination therapies.
Conclusions:
- Significant progress has been made in understanding GISTs and their response to therapy.
- New questions arise with the expanding use of imatinib mesylate.
- Targeted molecular therapies for GISTs may serve as a paradigm for treating other common cancers.