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Abstract
10087 Background: The tyrosine kinase inhibitor (TKI) imatinib is the first-line palliative treatment inhibiting mutated KIT. Our aim was to compare the survival of patients only surgically treated in the preimatinib era with that after introduction of the drug in a defined population. Methods: During 2002-2008, 107 GIST patients were treated. Neoadjuvant imatinib (n=10) was used for organ-preservation, patients with R0-resection received imatinib adjuvantly (n=45), and those with R2-resection had life-long palliative imatinib (n=28) Patients with low/intermediate risk GISTs (n=23) underwent surgery only. These groups were compared with historic controls from our population-based series (n= 259) matched for sex, age, tumor size, and mitotic rate. Mutational analysis of KIT and PDGFRA was performed in all cases. Results: In the high-risk group 10 patients had neoadjuvant imatinib with 100% 5-year estimated progression-free survival (vs. 30% in 89 matched historic controls, p<0.001). The mean size of these tumors decreased in diameter from 20.3 cm to 10.1 cm and the surgical procedures were thus limited (gastric resection, wedge liver resections, and salvage of cardia, pancreas and rectum). 45 patients with high risk GIST had adjuvant imatinib after radical (R0) surgery, with 85% 5-year estimated recurrence-free survival (p<0.001) vs. 35% in historic controls; 28 patients were treated with palliative imatinib after tumor reduction (R2) with 55% 5-year estimated over all survival vs. 5% in 29 historic controls (p<0.001). In the low/intermediate-risk (NIH consensus) group there were no recurrences after surgery only vs. 3 in the historic control group. Conclusions: Neoadjuvant treatment with imatinib is recommended for patients with bulky tumors to facilitate organ preserving surgery, and adjuvant imatinib only for high (not intermediate) risk patients after with R0 resection. Palliative imatinib improves survival in R2 resected patients. No significant financial relationships to disclose.
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