P Reichardt1, J-Y Blay2, I Boukovinas3, T Brodowicz4, J M Broto5, P G Casali6, M Decatris7, M Eriksson8, H Gelderblom9, P Kosmidis10, A Le Cesne11, A L Pousa12, M Schlemmer13, J Verweij14, H Joensuu15. 1. Interdisciplinary Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany. Electronic address: peter.reichardt@helios-kliniken.de. 2. Department of Medicine, Centre Léon-Bérard, Lyon, France. 3. 2nd Department of Medical Oncology, Theagenion Cancer Hospital, Thessaloniki, Greece. 4. Department of Internal Medicine 1/Division of Oncology, Medical University Vienna--General Hospital, Vienna, Austria. 5. COTMES (Comité de Tumores Músculo-Esqueléticos), Mallorca, Spain. 6. Department of Cancer Medicine, Istituto Nazionale dei Tumori, Milan, Italy. 7. Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus. 8. Skane University Hospital and Lund University, Lund, Sweden. 9. Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands. 10. Medical Oncology Department, Hygeia Hospital, Athens, Greece. 11. Department of Medicine, Institut Gustave Roussy, Villejuif Cedex, France. 12. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. 13. Medical Clinic III, Ludwig Maximilians University, Munich, Germany. 14. Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands. 15. Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
Abstract
BACKGROUND: The management of primary gastrointestinal stromal tumours (GISTs) has evolved with the introduction of adjuvant therapy. Recently reported results of the SSG XVIII/AIO trial by the Scandinavian Sarcoma Group (SSG) and the German Working Group on Medical Oncology (AIO) represent a significant change in the evidence for adjuvant therapy duration. The objectives of this European Expert Panel meeting were to describe the optimal management and best practice for the systemic adjuvant treatment of patients with primary GISTs. MATERIALS AND METHODS: A panel of medical oncology experts from European sarcoma research groups were invited to a 1-day workshop. Several questions and discussion points were selected by the organising committee prior to the conference. The experts reviewed the current literature of all clinical trials available on adjuvant therapy for primary GISTs, considered the quality evidence and formulated recommendations for each discussion point. RESULTS: Clinical issues were identified and provisional clinical opinions were formulated for adjuvant treatment patient selection, imatinib dose, duration and patient recall, mutational analysis and follow-up of primary GIST patients. Adjuvant imatinib 400 mg/day for 3 years duration is a standard treatment in all patients with significant risk of recurrence following resection of primary GISTs. Patient selection for adjuvant therapy should be based on any of the three commonly used patient risk stratification schemes. R1 surgery (versus R0) alone is not an indication for adjuvant imatinib in low-risk GIST. Recall and imatinib restart could be proposed in patients who discontinued 1-year adjuvant imatinib within the previous 3 months and may be considered on a case-by-case basis in patients who discontinued within the previous year. Mutational analysis is recommended in all cases of GISTs using centralised laboratories with good quality control. Treatment is not recommended in an imatinib-insensitive D842V-mutated GIST. During adjuvant treatment, patients are recommended to be clinically assessed at 1- to 3-month intervals. Upon discontinuation, computed tomography scan (CT) scans are recommended every 3 to 4 months for 2 years when the risk of relapse is highest, followed by every 6 months until year 5 and annually until year 10 after treatment discontinuation. CONCLUSIONS: Key points in systemic adjuvant treatment and clinical management of primary GISTs as well as open questions were identified during this European Expert Panel meeting on GIST management.
BACKGROUND: The management of primary gastrointestinal stromal tumours (GISTs) has evolved with the introduction of adjuvant therapy. Recently reported results of the SSG XVIII/AIO trial by the Scandinavian Sarcoma Group (SSG) and the German Working Group on Medical Oncology (AIO) represent a significant change in the evidence for adjuvant therapy duration. The objectives of this European Expert Panel meeting were to describe the optimal management and best practice for the systemic adjuvant treatment of patients with primary GISTs. MATERIALS AND METHODS: A panel of medical oncology experts from European sarcoma research groups were invited to a 1-day workshop. Several questions and discussion points were selected by the organising committee prior to the conference. The experts reviewed the current literature of all clinical trials available on adjuvant therapy for primary GISTs, considered the quality evidence and formulated recommendations for each discussion point. RESULTS: Clinical issues were identified and provisional clinical opinions were formulated for adjuvant treatment patient selection, imatinib dose, duration and patientrecall, mutational analysis and follow-up of primary GIST patients. Adjuvant imatinib 400 mg/day for 3 years duration is a standard treatment in all patients with significant risk of recurrence following resection of primary GISTs. Patient selection for adjuvant therapy should be based on any of the three commonly used patient risk stratification schemes. R1 surgery (versus R0) alone is not an indication for adjuvant imatinib in low-risk GIST. Recall and imatinib restart could be proposed in patients who discontinued 1-year adjuvant imatinib within the previous 3 months and may be considered on a case-by-case basis in patients who discontinued within the previous year. Mutational analysis is recommended in all cases of GISTs using centralised laboratories with good quality control. Treatment is not recommended in an imatinib-insensitive D842V-mutated GIST. During adjuvant treatment, patients are recommended to be clinically assessed at 1- to 3-month intervals. Upon discontinuation, computed tomography scan (CT) scans are recommended every 3 to 4 months for 2 years when the risk of relapse is highest, followed by every 6 months until year 5 and annually until year 10 after treatment discontinuation. CONCLUSIONS: Key points in systemic adjuvant treatment and clinical management of primary GISTs as well as open questions were identified during this European Expert Panel meeting on GIST management.
Authors: Fadi Farhat; Abdulaziz Al Farsi; Ahmed Mohieldin; Bassim Al Bahrani; Eman Sbaity; Hassan Jaffar; Joseph Kattan; Kakil Rasul; Khairallah Saad; Tarek Assi; Waleed El Morsi; Rafid A Abood Journal: World J Clin Cases Date: 2020-02-06 Impact factor: 1.337