Abstract
Simple SummaryGastrointestinal stromal tumors (GIST) are the most common type of gastrointestinal sarcomas. Recent treatment advancements have led to a significant improvement in the survival of patients living with GIST. Nevertheless, patients with metastatic GIST will eventually require multiple lines of treatment. The use of immunotherapies could potentially fill the role of such treatments and potentiate the current therapies. This article reviews the mechanism by which the immune system interacts with GIST and discusses several studies on the use of immunotherapies in GIST.Gastrointestinal stromal tumors (GIST) are the most common mesenchymal soft tissue sarcoma of the gastrointestinal tract. The management of locally advanced or metastatic unresectable GIST involves detecting KIT, PDGFR, or other molecular alterations targeted by imatinib and other tyrosine kinase inhibitors. The role of immunotherapy in soft tissue sarcomas is growing fast due to multiple clinical and pre-clinical studies with no current standard of care. The potential therapies include cytokine-based therapy, immune checkpoint inhibitors, anti-KIT monoclonal antibodies, bi-specific monoclonal antibodies, and cell-based therapies. Here we provide a comprehensive review of the immunotherapeutic strategies for GIST.
Highlights
Published: 14 July 2021Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal (GI) tract, accounting for 80% of all GI sarcomas and 0.1 to 3% of all GI malignancies [1], affecting 1.1 every 100,000 persons per year worldwide [2]
Gastrointestinal stromal tumors (GIST) arises from the same lineage as the interstitial cells of Cajal (ICC), which function as pacemaker cells and regulate the GI tract peristalsis, it is not clear if these tumors arise directly from the mature cells or their precursors
natural killer cells (NK) cells are less frequent than CD3+ T cells in GIST and are associated significantly with lower proliferation index (PI), stomach localization, reduced relapse rate, and improved progression-free survival [19]
Summary
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal (GI) tract, accounting for 80% of all GI sarcomas and 0.1 to 3% of all GI malignancies [1], affecting 1.1 every 100,000 persons per year worldwide [2]. The cell-surface tyrosine kinase KIT receptor is vital to the function and survival of ICCs, with 85% of GIST occurring due to mutually exclusive activating mutations of KIT (CD-117) or platelet-derived growth factor receptor alpha (PDGFRA) [5,6]. A KIT tyrosine kinase inhibitor, is the first-line systemic therapy for GIST. It can achieve a clinical response in 80% of patients leading to an impressive median overall survival (OS) of 3.9 years and progression-free survival (PFS) of 1.9 years [7,9]. The microenvironment of GIST is populated by tumor-infiltrating immune cells These cells have an essential role in tumor surveillance and can potentially remove imatinib resistant clones, enhancing imatinib activity. We review the role of immunotherapy in GIST treatment and the ongoing trials [12]
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