Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors

Chandrajit P. Raut, Matthew Posner, Jayesh Desai, Jeffrey A. Morgan, Suzanne George, David Zahrieh, Christopher D.M. Fletcher, George D. Demetri, Monica M. Bertagnolli

Research output: Contribution to journalArticle

322 Citations (Scopus)

Abstract

Purpose: While targeted inhibitors of tyrosine kinase activity demonstrate dramatic efficacy in the majority of patients with advanced gastrointestinal stromal tumors (GISTs), cure remains elusive and resistance to systemic therapy is a challenge. To assess the role of surgery in multimodality management of GISTs, we studied postoperative outcomes in patients treated with targeted kinase inhibitors for advanced GIST. Methods: We evaluated outcomes in a single institution series of 69 consecutive patients who underwent surgery for advanced GISTs while receiving kinase inhibitors. Patients were categorized based on extent of disease before surgery (stable disease, limited disease progression, generalized disease progression) and surgical result (no evidence of disease, minimal residual disease, bulky residual disease). Results: Disease status before surgery was associated with surgical result (P < .0001; median follow-up, 14.6 months). After surgery, there was no evidence of disease in 78%, 25%, and 7% of patients with stable disease, limited progression, and generalized progression, respectively. Bulky residual disease remained after surgery in 4%, 16%, and 43% of the patients with stable disease, limited progression, and generalized progression. Twelve-month progression-free survival was 80%, 33%, and 0% for patients with stable disease, limited progression, and generalized progression (P < .0001). Twelve-month overall survival was 95%, 86%, and 0% for patients with stable disease, limited progression, and generalized progression (P < .0001). Conclusion: Patients with advanced GISTs exhibiting stable disease or limited progression on kinase inhibitor therapy have prolonged overall survival after debulking procedures. Surgery has little to offer in the setting of generalized progression.

Original languageEnglish (US)
Pages (from-to)2325-2331
Number of pages7
JournalJournal of Clinical Oncology
Volume24
Issue number15
DOIs
StatePublished - May 20 2006
Externally publishedYes

Fingerprint

Gastrointestinal Stromal Tumors
Phosphotransferases
Disease Progression
Therapeutics
Survival
Residual Neoplasm
Protein-Tyrosine Kinases
Disease-Free Survival

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors. / Raut, Chandrajit P.; Posner, Matthew; Desai, Jayesh; Morgan, Jeffrey A.; George, Suzanne; Zahrieh, David; Fletcher, Christopher D.M.; Demetri, George D.; Bertagnolli, Monica M.

In: Journal of Clinical Oncology, Vol. 24, No. 15, 20.05.2006, p. 2325-2331.

Research output: Contribution to journalArticle

Raut, CP, Posner, M, Desai, J, Morgan, JA, George, S, Zahrieh, D, Fletcher, CDM, Demetri, GD & Bertagnolli, MM 2006, 'Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors', Journal of Clinical Oncology, vol. 24, no. 15, pp. 2325-2331. https://doi.org/10.1200/JCO.2005.05.3439
Raut, Chandrajit P. ; Posner, Matthew ; Desai, Jayesh ; Morgan, Jeffrey A. ; George, Suzanne ; Zahrieh, David ; Fletcher, Christopher D.M. ; Demetri, George D. ; Bertagnolli, Monica M. / Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors. In: Journal of Clinical Oncology. 2006 ; Vol. 24, No. 15. pp. 2325-2331.
@article{c648eb24fdee433c89abb832f00dd989,
title = "Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors",
abstract = "Purpose: While targeted inhibitors of tyrosine kinase activity demonstrate dramatic efficacy in the majority of patients with advanced gastrointestinal stromal tumors (GISTs), cure remains elusive and resistance to systemic therapy is a challenge. To assess the role of surgery in multimodality management of GISTs, we studied postoperative outcomes in patients treated with targeted kinase inhibitors for advanced GIST. Methods: We evaluated outcomes in a single institution series of 69 consecutive patients who underwent surgery for advanced GISTs while receiving kinase inhibitors. Patients were categorized based on extent of disease before surgery (stable disease, limited disease progression, generalized disease progression) and surgical result (no evidence of disease, minimal residual disease, bulky residual disease). Results: Disease status before surgery was associated with surgical result (P < .0001; median follow-up, 14.6 months). After surgery, there was no evidence of disease in 78{\%}, 25{\%}, and 7{\%} of patients with stable disease, limited progression, and generalized progression, respectively. Bulky residual disease remained after surgery in 4{\%}, 16{\%}, and 43{\%} of the patients with stable disease, limited progression, and generalized progression. Twelve-month progression-free survival was 80{\%}, 33{\%}, and 0{\%} for patients with stable disease, limited progression, and generalized progression (P < .0001). Twelve-month overall survival was 95{\%}, 86{\%}, and 0{\%} for patients with stable disease, limited progression, and generalized progression (P < .0001). Conclusion: Patients with advanced GISTs exhibiting stable disease or limited progression on kinase inhibitor therapy have prolonged overall survival after debulking procedures. Surgery has little to offer in the setting of generalized progression.",
author = "Raut, {Chandrajit P.} and Matthew Posner and Jayesh Desai and Morgan, {Jeffrey A.} and Suzanne George and David Zahrieh and Fletcher, {Christopher D.M.} and Demetri, {George D.} and Bertagnolli, {Monica M.}",
year = "2006",
month = "5",
day = "20",
doi = "10.1200/JCO.2005.05.3439",
language = "English (US)",
volume = "24",
pages = "2325--2331",
journal = "Journal of Clinical Oncology",
issn = "0732-183X",
publisher = "American Society of Clinical Oncology",
number = "15",

}

TY - JOUR

T1 - Surgical management of advanced gastrointestinal stromal tumors after treatment with targeted systemic therapy using kinase inhibitors

AU - Raut, Chandrajit P.

AU - Posner, Matthew

AU - Desai, Jayesh

AU - Morgan, Jeffrey A.

AU - George, Suzanne

AU - Zahrieh, David

AU - Fletcher, Christopher D.M.

AU - Demetri, George D.

AU - Bertagnolli, Monica M.

PY - 2006/5/20

Y1 - 2006/5/20

N2 - Purpose: While targeted inhibitors of tyrosine kinase activity demonstrate dramatic efficacy in the majority of patients with advanced gastrointestinal stromal tumors (GISTs), cure remains elusive and resistance to systemic therapy is a challenge. To assess the role of surgery in multimodality management of GISTs, we studied postoperative outcomes in patients treated with targeted kinase inhibitors for advanced GIST. Methods: We evaluated outcomes in a single institution series of 69 consecutive patients who underwent surgery for advanced GISTs while receiving kinase inhibitors. Patients were categorized based on extent of disease before surgery (stable disease, limited disease progression, generalized disease progression) and surgical result (no evidence of disease, minimal residual disease, bulky residual disease). Results: Disease status before surgery was associated with surgical result (P < .0001; median follow-up, 14.6 months). After surgery, there was no evidence of disease in 78%, 25%, and 7% of patients with stable disease, limited progression, and generalized progression, respectively. Bulky residual disease remained after surgery in 4%, 16%, and 43% of the patients with stable disease, limited progression, and generalized progression. Twelve-month progression-free survival was 80%, 33%, and 0% for patients with stable disease, limited progression, and generalized progression (P < .0001). Twelve-month overall survival was 95%, 86%, and 0% for patients with stable disease, limited progression, and generalized progression (P < .0001). Conclusion: Patients with advanced GISTs exhibiting stable disease or limited progression on kinase inhibitor therapy have prolonged overall survival after debulking procedures. Surgery has little to offer in the setting of generalized progression.

AB - Purpose: While targeted inhibitors of tyrosine kinase activity demonstrate dramatic efficacy in the majority of patients with advanced gastrointestinal stromal tumors (GISTs), cure remains elusive and resistance to systemic therapy is a challenge. To assess the role of surgery in multimodality management of GISTs, we studied postoperative outcomes in patients treated with targeted kinase inhibitors for advanced GIST. Methods: We evaluated outcomes in a single institution series of 69 consecutive patients who underwent surgery for advanced GISTs while receiving kinase inhibitors. Patients were categorized based on extent of disease before surgery (stable disease, limited disease progression, generalized disease progression) and surgical result (no evidence of disease, minimal residual disease, bulky residual disease). Results: Disease status before surgery was associated with surgical result (P < .0001; median follow-up, 14.6 months). After surgery, there was no evidence of disease in 78%, 25%, and 7% of patients with stable disease, limited progression, and generalized progression, respectively. Bulky residual disease remained after surgery in 4%, 16%, and 43% of the patients with stable disease, limited progression, and generalized progression. Twelve-month progression-free survival was 80%, 33%, and 0% for patients with stable disease, limited progression, and generalized progression (P < .0001). Twelve-month overall survival was 95%, 86%, and 0% for patients with stable disease, limited progression, and generalized progression (P < .0001). Conclusion: Patients with advanced GISTs exhibiting stable disease or limited progression on kinase inhibitor therapy have prolonged overall survival after debulking procedures. Surgery has little to offer in the setting of generalized progression.

UR - http://www.scopus.com/inward/record.url?scp=33744795769&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33744795769&partnerID=8YFLogxK

U2 - 10.1200/JCO.2005.05.3439

DO - 10.1200/JCO.2005.05.3439

M3 - Article

C2 - 16710031

AN - SCOPUS:33744795769

VL - 24

SP - 2325

EP - 2331

JO - Journal of Clinical Oncology

JF - Journal of Clinical Oncology

SN - 0732-183X

IS - 15

ER -