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Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors
Published on: February 19, 2022
Advances and Challenges on Management of Gastrointestinal Stromal Tumors
Lin Mei1, Wei Du2, Michael Idowu2
1Hematology, Oncology and Palliative Care, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States.
Abstract:
Gastrointestinal stromal tumors (GISTs) originate from interstitial cells of Cajal and account for over 5,000 newly diagnosed cases in the United States. The discovery of activated KIT and PDGFRA mutations and introduction of imatinib revolutionized the treatment strategy and opened up the new era of target therapy for solid tumors. Although surgery remains the primary modality of treatment for curative purpose, almost half of the patients experienced disease recurrence. Tailoring (neo)-adjuvant treatment with imatinib is ongoing to meet the need for an effective therapy. Currently, two drugs (sunitinib and regorafenib) have obtained Food and Drug Administration approval for GISTs after imatinib failure. However, most of the patients eventually progress due to primary or secondary resistance. Deeper understanding of the molecular mechanisms will guide us to develop personalized strategies in the future. Discussion in this review includes current standard management and the most recent advances and multiple ongoing clinical trials with different approaches. This review will provide further steps to be taken to conquer refractory disease.
Insights
Gastrointestinal stromal tumors (GISTs) are rare cancers. Targeted therapies like imatinib have improved outcomes, but resistance remains a challenge, necessitating further research into advanced treatments.
Area of Science:
- Oncology
- Gastroenterology
- Molecular Biology
Background:
- Gastrointestinal stromal tumors (GISTs) originate from interstitial cells of Cajal.
- Activated KIT and PDGFRA mutations are key drivers in GIST development.
- Imatinib revolutionized GIST treatment, initiating targeted therapy for solid tumors.
Purpose of the Study:
- To review current management strategies for GISTs.
- To discuss recent advances and ongoing clinical trials in GIST therapy.
- To explore future directions for overcoming treatment resistance in GISTs.
Main Methods:
- Literature review of GIST management.
- Analysis of current targeted therapies and resistance mechanisms.
- Overview of ongoing clinical trials and novel therapeutic approaches.
Main Results:
- Surgery is the primary curative treatment, but recurrence is common.
- Imatinib is a cornerstone therapy, with sunitinib and regorafenib approved for later lines.
- Primary and secondary resistance to targeted therapies remain significant challenges.
Conclusions:
- Despite advances, refractory GIST remains a clinical challenge.
- Understanding molecular mechanisms is crucial for developing personalized strategies.
- Further research and clinical trials are essential to conquer refractory GIST.
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