Clinical significance of surgical intervention for imatinib-resistant gastrointestinal stromal tumors in the era of multiple tyrosine kinase inhibitors

Surgery Today (2021)Cite this article

Abstract

Purpose

Imatinib is the standard treatment for unresectable and metastatic GIST. In the late stages, patients undergoing imatinib show drug resistance. Surgical intervention has been occasionally performed for resistant lesions. However, the clinical significance of such intervention remains unclear.

Methods

Between 2006 and 2015, 37 patients were diagnosed with imatinib-resistant GISTs. We performed surgical intervention only for localized resistant lesions. We retrospectively investigated the background characteristics, data on surgical intervention and subsequent treatment, progression-free survival (PFS), and overall survival (OS).

Results

Eighteen patients diagnosed with localized resistance received surgical intervention (S-group) and 19 patients diagnosed with generalized resistance were received other TKIs (M-group). In S-group, no serious complications occurred, and all patients restarted imatinib after resection. The median PFS was 14.5 months. Five patients underwent surgical intervention multiple times followed by the continuation of imatinib, and the median duration of imatinib continuation was 22.2 months. Second-line TKIs were administered to 93% of the patients and the dose-intensity and outcome were similar in both groups. The median OS was 47.2 months after surgery.

Conclusions

Surgical intervention could be performed safely and therefore could be followed by the continuation of TKI therapy. Surgical intervention based on the appropriate criteria of resistance might thus be useful for imatinib-resistant GISTs.

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Affiliations

  1. Department of Gastroenterological Surgery, Ikeda City Hospital, Osaka, Japan

    Noriko Wada & Yusuke Akamaru

  2. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Noriko Wada, Tsuyoshi Takahashi, Yukinori Kurokawa, Kiyokazu Nakajima, Masahiro Koh, Koji Tanaka, Yasuhiro Miyazaki, Tomoki Makino, Makoto Yamasaki, Hidetoshi Eguchi & Yuichiro Doki

  3. Department of Surgery, National Cancer Center Hospital, Tokyo, Japan

    Toshirou Nishida

  4. Department of Surgery, Osaka General Medical Center, Osaka, Japan

    Masaaki Motoori

  5. Department of Surgery, Faculty of Medicine, Kinki University, Osaka, Japan

    Yutaka Kimura

Authors
  1. Noriko Wada
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  2. Tsuyoshi Takahashi
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  3. Yukinori Kurokawa
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  4. Kiyokazu Nakajima
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  5. Toshirou Nishida
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  6. Masahiro Koh
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  7. Yusuke Akamaru
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  8. Masaaki Motoori
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  9. Yutaka Kimura
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  10. Koji Tanaka
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  11. Yasuhiro Miyazaki
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  12. Tomoki Makino
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  13. Makoto Yamasaki
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  14. Hidetoshi Eguchi
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  15. Yuichiro Doki
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Correspondence to Tsuyoshi Takahashi.

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Wada, N., Takahashi, T., Kurokawa, Y. et al. Clinical significance of surgical intervention for imatinib-resistant gastrointestinal stromal tumors in the era of multiple tyrosine kinase inhibitors. Surg Today (2021). https://doi.org/10.1007/s00595-021-02241-5

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Keywords

  • Gastrointestinal stromal tumor
  • Imatinib-resistance
  • Surgical intervention