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
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