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Neoadjuvant Imatinib in Locally Advanced Gastrointestinal Stromal Tumors (GIST): The EORTC STBSG Experience

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

Abstract

Background

Preoperative imatinib therapy of locally advanced GIST may facilitate resection and decrease morbidity of the procedure.

Methods

We have pooled databases from 10 EORTC STBSG sarcoma centers and analyzed disease-free survival (DFS) and disease-specific survival (DSS) in 161 patients with locally advanced, nonmetastatic GISTs who received neoadjuvant imatinib. OS was calculated from start of imatinib therapy for locally advanced disease until death or last follow-up (FU) after resection of the GIST. DFS was calculated from date of resection to date of disease recurrence or last FU. Median FU time was 46 months.

Results

The primary tumor was located in the stomach (55 %), followed by rectum (20 %), duodenum (10 %), ileum/jejunum/other (11 %), and esophagus (3 %). The tumor resection after preoperative imatinib (median time on therapy, 40 weeks) was R0 in 83 %. Only two patients have demonstrated disease progression during neoadjuvant therapy. Five-year DSS/DFS rates were 95/65 %, respectively, median OS was 104 months, and median DFS was not reached. There were 56 % of patients who continued imatinib after resection. Thirty-seven GIST recurrences were diagnosed (only 5 local relapses). The most common mutations affected exon 11 KIT (65 %). Poorer DFS was related to primary tumor location in small bowel and lack of postoperative therapy with imatinib.

Conclusions

Our analysis comprising the largest group of GIST patients treated with neoadjuvant imatinib in routine practice indicates excellent long-term results of combined therapy in locally advanced GISTs.

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Disclosures

Piotr Rutkowski received Honoraria and travel Grants from Novartis and Pfizer, member of Advisory Board for Novartis. Alessandro Gronchi received compensation for advisory boards, honoraria and research Grants from Novartis Pharma. Patrick Schoffski received research Grants from Novartis, Honoraria for participation in advisory and educational function from Novartis. Stefan Sleijfer received research funding and advisory board Novartis. Alex LeCesne received Honoraria Novartis, Pfizer, Pharmamar, GSK. Sebastian Bauer received Honoraria and travel support from Novartis and Pfizer. Frits van Coevorden received travel compensations from Novartis and Pharmamar, member of Advisory Board for Novartis

Author information

Authors and Affiliations

  1. Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland

    Piotr Rutkowski MD, PhD & Elzbieta Bylina BSc

  2. Department of Surgery, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy

    Alessandro Gronchi MD & Marco Fiore MD

  3. Department of Surgical Oncology and Thoracic Surgery, Mannheim University Medical Center, Mannheim, Germany

    Peter Hohenberger MD, PhD

  4. Department of Surgery, Institut Gustave Roussy, Villejuif Paris, France

    Sylvie Bonvalot MD, PhD

  5. University Hospitals KU, Leuven, Belgium

    Patrick Schöffski MD, MPH

  6. Department of Medical Oncology, University of Duisburg-Essen, Essen, Germany

    Sebastian Bauer MD, PhD, Buu-Phuc Nguyen MD & Mathias Hoiczyk MD

  7. Adult Mesenchymal Tumour Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy

    Elena Fumagalli MD & Paolo G. Casali MD

  8. Department of General, Liver and Transplant Surgery, Medical University of Warsaw, Warsaw, Poland

    Pawel Nyckowski MD, PhD

  9. Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Jan Martijn Kerst MD, PhD & Annemieke Cats MD, PhD

  10. Department of Medical Oncology, Institut Gustave Roussy, Villejuif, Paris, France

    Axel Le Cesne MD

  11. Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Essen, Germany

    Jürgen Treckmann MD, PhD

  12. Department of Surgery, Institut Bergonié, Regional Cancer Center, Bordeaux, France

    Eberhard Stoeckle MD

  13. Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

    Johannes. H. W. de Wilt MD, PhD, Ronald Tielen MD & Winette van der Graaf MD, PhD

  14. Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands

    Stefan Sleijfer MD, PhD

  15. Department of Surgical Oncology, Erasmus MC, Rotterdam, The Netherlands

    Cornelis Verhoef MD, PhD

  16. Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands

    Frits van Coevorden MD, PhD

Authors
  1. Piotr Rutkowski MD, PhD
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  2. Alessandro Gronchi MD
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  3. Peter Hohenberger MD, PhD
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  4. Sylvie Bonvalot MD, PhD
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  5. Patrick Schöffski MD, MPH
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  7. Elena Fumagalli MD
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  8. Pawel Nyckowski MD, PhD
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  9. Buu-Phuc Nguyen MD
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  11. Marco Fiore MD
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  12. Elzbieta Bylina BSc
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  13. Mathias Hoiczyk MD
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  14. Annemieke Cats MD, PhD
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  15. Paolo G. Casali MD
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  16. Axel Le Cesne MD
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  17. Jürgen Treckmann MD, PhD
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  18. Eberhard Stoeckle MD
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  19. Johannes. H. W. de Wilt MD, PhD
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  20. Stefan Sleijfer MD, PhD
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  21. Ronald Tielen MD
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  22. Winette van der Graaf MD, PhD
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  23. Cornelis Verhoef MD, PhD
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  24. Frits van Coevorden MD, PhD
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Corresponding author

Correspondence to Frits van Coevorden MD, PhD.

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Rutkowski, P., Gronchi, A., Hohenberger, P. et al. Neoadjuvant Imatinib in Locally Advanced Gastrointestinal Stromal Tumors (GIST): The EORTC STBSG Experience. Ann Surg Oncol 20, 2937–2943 (2013). https://doi.org/10.1245/s10434-013-3013-7

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  • DOI: https://doi.org/10.1245/s10434-013-3013-7

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