DIAGNOSIS AND MANAGEMENT OF GASTROINTESTINAL STROMAL TUMORS (GISTS) OF THE STOMACH

DOI 82 References
  • TSUTSUI Shusaku
    Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine.
  • NAKAJIMA Kiyokazu
    Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine.
  • YAMADA Takuya
    Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine.
  • TAKEHARA Tetsuo
    Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine.

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  • 胃GISTの診断と治療

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Description

The gastrointestinal stromal tumour (GIST) is the most common sarcoma of the intestinal tract, known to be refractory to conventional chemotherapy or radiation. Cure can be obtained only by complete surgical removal of the GIST. GISTs are considered to be driven by a gain-of-function mutation in the c-kit or PDGFRA gene. Recognition of the key role played by the receptor tyrosine kinases KIT and PDGFRα in the pathogenesis of GISTs led to the development of imatinib. Imatinib exhibited remarkable clinical effects on advanced GISTs. Its efficacy is dependent on the KIT mutation status. However, the clinical efficacy of imatinib has been limited by the concerns that patients will develop a refractory disease that is resistant to imatinib. Although sunitinib bas been approved as second-line therapy for GISTs following imatinib failure, the benefits of this drug also limited by the emergence of refractory disease. No agent has yet reached regulatory approval for the management of GISTs following the failure of both imatinib and sunitinib. Thus, advanced cases of GIST may require a multidisciplinary approach. The rapid improvement of our understanding of GIST biology and resistance mechanisms towards imatinib and sunitinib will facilitate the development of novel treatment strategies.

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