Gastrointestinal%20stromal%20tumor Treatment

Prior to Therapy

• Assess present disease state for treatment monitoring purpose
• Inform & discuss w/ patient that the tumor cannot be cured, the duration of treatment required by the condition including the course of possible disease progression
• Determine the cardiac status
  • Physical activity should not be severely limited
  • No myocardial infarction within the last 2 months
• Laboratory tests [eg liver function tests, complete blood count (CBC), etc]
  

Chemotherapy

Imatinib

• Recommended treatment for gastrointestinal stromal tumor (GIST) that is unresectable &/or metastatic
  • Adjuvant therapy for patients w/ high risk of relapse & for ruptured tumor during surgery

• Increases survival rate in patients w/ metastatic &/or unresectable GIST
• When Imatinib is used pre-operative, positron emission tomography (PET) scan should be used to assess response

Discontinuation of Treatment

• Stop Imatinib if intolerable side effects occur & restart once toxicity resolves
• For less severe toxicity, consider decreasing the dose

Sunitinib

• A 2nd-line agent that may be used if intolerance to Imatinib develops, if tumor is Imatinib resistant, or disease progression occurs
• Demonstrated efficacy in terms of progression-free survival on a “4 weeks on-2 weeks off” regimen

Regorafenib

• A 3rd-line agent for patients unresponsive to both Imatinib & Sunitinib
• Shown to prolong progression-free survival in a prospective placebo-controlled randomized trial