Neoadjuvant use of sunitinib in locally advanced GIST with intolerance to imatinib

Gastrointestinal stromal tumors (GIST) arise from precursor cells in the myenteric plexus and comprise the most common mesenchymal tumors of the gastrointestinal tract. Surgical resection is the mainstay of therapy for localized disease. Recurrent, unresectable, and metastatic tumors are associated with a poor prognosis given their resistance to conventional chemotherapy and radiation. Advances in the understanding of molecular pathophysiology of GIST and the use of targeted small-molecule therapies have resulted in dramatic increases in survival. Preliminary data have demonstrated benefits in using imatinib in a neoadjuvant setting; however, there are no studies to date analyzing the use of neoadjuvant sunitinib in primary advanced GIST. Here we present the case of a patient with locally advanced primary GIST who developed severe toxicity on imatinib therapy and was successfully treated with sunitinib in the neoadjuvant setting to achieve complete surgical resection.