Gastrointestinal stromal tumor medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
The predominant therapy for gastrointestinal stromal tumor is surgical resection. Adjunctive chemotherapy/tyrosine Kinase Inhibitor therapy may be required. | The predominant therapy for gastrointestinal stromal tumor is surgical resection. Adjunctive [[chemotherapy]]/[[tyrosine Kinase Inhibitor]] therapy may be required. | ||
==Medical Therapy== | ==Medical Therapy== | ||
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===Chemotherapy=== | ===Chemotherapy=== | ||
Before the advent of molecularly targeted therapy with | Before the advent of molecularly targeted therapy with tyrosine Kinase Inhibitor, efforts to treat GIST with conventional cytotoxic chemotherapy were essentially futile. The extreme resistance of GIST to chemotherapy may be caused, in part, by the increased expression of P-glycoprotein, the product of the MDR-1 (multidrug resistance-1) gene, and MRP1 (multidrug resistance protein-1), which are cellular efflux pumps that may prevent chemotherapeutic agents from reaching therapeutic intracellular concentrations in GIST. There is universal agreement that standard chemotherapy has no role in the primary therapy of GIST. | ||
===Tyrosine Kinase Inhibitor Therapy=== | ===Tyrosine Kinase Inhibitor Therapy=== | ||
TKIs have revolutionized the management of GIST. The TKI imatinib mesylate is used as the first-line treatment for unresectable, metastatic, or recurrent GIST. Although complete responses are rare, a large majority of patients with metastatic or inoperable GIST have either a partial response or disease stabilization after starting imatinib. Median survival rates have gone from less than 2 years to more than 5 years since the advent of imatinib therapy. | TKIs have revolutionized the management of GIST. The TKI [[imatinib mesylate]] is used as the first-line treatment for unresectable, metastatic, or recurrent GIST. Although complete responses are rare, a large majority of patients with metastatic or inoperable GIST have either a partial response or disease stabilization after starting [[imatinib]]. Median survival rates have gone from less than 2 years to more than 5 years since the advent of imatinib therapy. | ||
Therapy with neoadjuvant imatinib to reduce the tumor volume may be used for patients with very large primary GIST that cannot be removed without the risk of unacceptable morbidity. Additional therapy with adjuvant imatinib is being studied to determine whether imatinib reduces recurrence, which is common after resection of primary GIST. | Therapy with neoadjuvant imatinib to reduce the tumor volume may be used for patients with very large primary GIST that cannot be removed without the risk of unacceptable morbidity. Additional therapy with adjuvant imatinib is being studied to determine whether imatinib reduces recurrence, which is common after resection of primary GIST. | ||
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The most common toxicities associated with imatinib therapy, all of which may improve with prolonged treatment, include the following: | The most common toxicities associated with imatinib therapy, all of which may improve with prolonged treatment, include the following: | ||
*Fluid retention (especially periorbital edema or peripheral edema; occasionally pleural effusion or ascites) | *Fluid retention (especially periorbital edema or peripheral edema; occasionally pleural effusion or ascites) | ||
*Diarrhea | *[[Diarrhea]] | ||
*Nausea (may be diminished if taken with food) | *[[Nausea]] (may be diminished if taken with food) | ||
*Fatigue | *[[Fatigue]] | ||
*Muscle cramps | *[[Muscle cramps]] | ||
*Abdominal pain | *[[Abdominal pain]] | ||
*Rash | *[[Rash]] | ||
*Mild (macrocytic) anemia | *Mild (macrocytic) [[anemia]] | ||
Treatment with sunitinib may be considered for patients with life-threatening side effects from imatinib that cannot be managed by maximum supportive care.[4] Common side effects associated with sunitinib therapy include the following:[22,36] | Treatment with sunitinib may be considered for patients with life-threatening side effects from imatinib that cannot be managed by maximum supportive care.[4] Common side effects associated with sunitinib therapy include the following:[22,36] | ||
*Fatigue | *Fatigue | ||
*Nausea and vomiting | *Nausea and vomiting | ||
*Anemia | *Anemia | ||
*Neutropenia | *[[Neutropenia]] | ||
*Diarrhea | *Diarrhea | ||
*Abdominal pain | *Abdominal pain | ||
*Mucositis | *[[Mucositis]] | ||
*Anorexia | *[[Anorexia]] | ||
*Skin or hair discoloration | *Skin or hair discoloration | ||
*Hypothyroidism (thyroid function monitoring with TSH is generally recommended to detect subclinical hypothyroidism) | *[[Hypothyroidism]] (thyroid function monitoring with TSH is generally recommended to detect subclinical hypothyroidism) | ||
Revision as of 20:57, 3 September 2015
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Gastrointestinal stromal tumor Microchapters |
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Differentiating Gastrointestinal stromal tumor from other Diseases |
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Treatment |
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Gastrointestinal stromal tumor medical therapy On the Web |
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American Roentgen Ray Society Images of Gastrointestinal stromal tumor medical therapy |
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Directions to Hospitals Treating Gastrointestinal stromal tumor |
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Risk calculators and risk factors for Gastrointestinal stromal tumor medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
Overview
The predominant therapy for gastrointestinal stromal tumor is surgical resection. Adjunctive chemotherapy/tyrosine Kinase Inhibitor therapy may be required.
Medical Therapy
Treatment Option Overview for GIST
- Surgical Therapy
- Chemotherapy
- Tyrosine Kinase Inhibitor Therapy
Chemotherapy
Before the advent of molecularly targeted therapy with tyrosine Kinase Inhibitor, efforts to treat GIST with conventional cytotoxic chemotherapy were essentially futile. The extreme resistance of GIST to chemotherapy may be caused, in part, by the increased expression of P-glycoprotein, the product of the MDR-1 (multidrug resistance-1) gene, and MRP1 (multidrug resistance protein-1), which are cellular efflux pumps that may prevent chemotherapeutic agents from reaching therapeutic intracellular concentrations in GIST. There is universal agreement that standard chemotherapy has no role in the primary therapy of GIST.
Tyrosine Kinase Inhibitor Therapy
TKIs have revolutionized the management of GIST. The TKI imatinib mesylate is used as the first-line treatment for unresectable, metastatic, or recurrent GIST. Although complete responses are rare, a large majority of patients with metastatic or inoperable GIST have either a partial response or disease stabilization after starting imatinib. Median survival rates have gone from less than 2 years to more than 5 years since the advent of imatinib therapy.
Therapy with neoadjuvant imatinib to reduce the tumor volume may be used for patients with very large primary GIST that cannot be removed without the risk of unacceptable morbidity. Additional therapy with adjuvant imatinib is being studied to determine whether imatinib reduces recurrence, which is common after resection of primary GIST.
Because disease progression has been reported to follow the cessation of imatinib therapy, patients with unresectable or metastatic disease are often treated with a TKI indefinitely, as long as the disease does not progress and patient tolerance permits.
Drug side effects
The most common toxicities associated with imatinib therapy, all of which may improve with prolonged treatment, include the following:
- Fluid retention (especially periorbital edema or peripheral edema; occasionally pleural effusion or ascites)
- Diarrhea
- Nausea (may be diminished if taken with food)
- Fatigue
- Muscle cramps
- Abdominal pain
- Rash
- Mild (macrocytic) anemia
Treatment with sunitinib may be considered for patients with life-threatening side effects from imatinib that cannot be managed by maximum supportive care.[4] Common side effects associated with sunitinib therapy include the following:[22,36]
- Fatigue
- Nausea and vomiting
- Anemia
- Neutropenia
- Diarrhea
- Abdominal pain
- Mucositis
- Anorexia
- Skin or hair discoloration
- Hypothyroidism (thyroid function monitoring with TSH is generally recommended to detect subclinical hypothyroidism)