gastrointestinal%20stromal%20tumor
GASTROINTESTINAL STROMAL TUMOR
Gastrointestinal stromal tumors are morphologically spindle cell, epithelioid, or occasionally pleomorphic mesenchymal tumors of the gastrointestinal tract.
Signs and symptoms of gastrointestinal tumor include presence of abdominal mass (which may be an incidental finding in endoscopy), gastrointestinal bleeding, hemoperitoneum, anemia and gastrointestinal perforation.

Principles of Therapy

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]

Pharmacotherapy

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
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Gastroenterology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Stephen Padilla, 13 Feb 2019
The Mandarin-speaking population in Singapore (SG) has deemed the translated Chronic Liver Disease Questionnaire (CLDQ) culturally acceptable, with only two items that needed revision in the finalized CLDQ-SG, according to a recent study.
Rachel Soon, 30 Sep 2016

Understanding the factors which induce visceral hypersensitivity (VH) in patients with functional gastrointestinal disorders (FGIDs) may help doctors manage patients and develop new treatments, says an expert.

Dr. Angela V. Ignacio, 21 Feb 2017
Administration of a probiotic appears to be a safe and effective therapeutic alternative for minimal hepatic encephalopathy (MHE) in patients with liver cirrhosis, according to a Greek study presented at the 26th Conference of the Asian Pacific Association for the Study of the Liver (APASL) held in Shanghai, China.