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Cytoreductive Surgery in Patients with Metastatic Gastrointestinal Stromal Tumor Treated with Sunitinib Malate

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

In patients with metastatic gastrointestinal stromal tumor (GIST) on first-line imatinib (IM) undergoing cytoreductive surgery, response to IM at time of surgery correlates with completeness of resection and progression-free and overall survival (PFS, OS). Impact of surgery in IM-resistant patients on second-line sunitinib (SU) is unknown.

Methods

Patients on SU undergoing surgery for metastatic GIST at our institution were reviewed. Response to SU at time of surgery was categorized as responsive disease (RD), limited progression (LP) or generalized progression (GP).

Results

Fifty patients underwent surgery after a median 6.7 months of SU. Forty patients (80%) had prior surgery at initial presentation of GIST; 16 (32%) underwent prior surgery on IM. At time of surgery on SU, 10 patients (20%) had RD, 22 (44%) had LP, and 18 (36%) had GP. Resections were macroscopically complete in 25 patients (50%); completeness of resection did not correlate with response to SU. Complication rate was 54%; reoperations were required in 16%. Median PFS after surgery and start of SU was 5.8 and 15.6 months, respectively (median follow-up 15.2 months). Corresponding median OS was 16.4 and 26.0 months, respectively. Differences in PFS and OS based on response to SU were not significant. Younger age was prognostic of survival.

Conclusion

Surgery is feasible in patients with metastatic GIST on SU, but incomplete resections are frequent and complication rates are high. Relevance of survival rates is difficult to assess given the selection bias. Benefits of surgery should be weighed against symptoms and alternative treatments.

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Disclosures

Chandrajit P. Raut—Novartis (honoraria, speaker’s bureau, advisory board). Suzanne George—Novartis (advisory board); Pfizer (advisory board). George D. Demetri—Novartis (honoraria, speaker’s bureau, advisory board); Pfizer (honoraria, advisory board).

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Authors and Affiliations

  1. Department of Surgery, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA, USA

    Chandrajit P. Raut MD, MSc & Monica M. Bertagnolli MD

  2. Department of Biostatistics, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA, USA

    Qian Wang PhD & Judith Manola MS

  3. Department of Medical Oncology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA, USA

    Jeffrey A. Morgan MD, Suzanne George MD, Andrew J. Wagner MD, PhD, James E. Butrynski MD, PhD & George D. Demetri MD

  4. Department of Pathology, Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA, USA

    Christopher D. M. Fletcher MD

Authors
  1. Chandrajit P. Raut MD, MSc
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  2. Qian Wang PhD
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  3. Judith Manola MS
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  4. Jeffrey A. Morgan MD
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  5. Suzanne George MD
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  6. Andrew J. Wagner MD, PhD
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  7. James E. Butrynski MD, PhD
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  8. Christopher D. M. Fletcher MD
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  9. George D. Demetri MD
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  10. Monica M. Bertagnolli MD
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Corresponding author

Correspondence to Chandrajit P. Raut MD, MSc.

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Raut, C.P., Wang, Q., Manola, J. et al. Cytoreductive Surgery in Patients with Metastatic Gastrointestinal Stromal Tumor Treated with Sunitinib Malate. Ann Surg Oncol 17, 407–415 (2010). https://doi.org/10.1245/s10434-009-0784-y

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  • DOI: https://doi.org/10.1245/s10434-009-0784-y

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