[Imatinib and beyond-what is important for surgery?]

Area of Science:

• Oncology
• Molecular Biology
• Gastrointestinal Surgery

Background:

• Gastrointestinal stromal tumors (GIST) treatment has advanced significantly with KIT inhibitors.
• Surgical resection of primary tumors remains crucial for curative treatment.
• Tyrosine kinase inhibitors (TKI) show improved long-term tumor control, especially after surgical resection.

Purpose of the Study:

• To review the evolving treatment landscape for GIST.
• To highlight the role of molecular predictors and multidisciplinary teams in GIST management.
• To discuss the impact of novel inhibitors on treatment-refractory GIST subtypes.

Main Methods:

• Review of current literature on GIST treatment strategies.
• Analysis of the efficacy of tyrosine kinase inhibitors (TKI) in various GIST settings.
• Discussion of emerging therapies for specific GIST mutations.

Main Results:

• Introduction of small molecule KIT inhibitors has dramatically improved GIST treatment.
• Surgical complete resection enhances the efficacy of TKI in metastatic GIST.
• Novel potent inhibitors demonstrate efficacy in PDGFR D842V and KIT-mutated GIST, including treatment-refractory cases.

Conclusions:

• Multimodal treatment approaches for GIST require complex molecular predictors and a deep understanding of GIST biology.
• Novel inhibitors are poised to significantly alter GIST treatment algorithms.
• Future GIST management will likely involve personalized therapies based on molecular profiles.