Abstract
Simple SummaryGastrointestinal stromal tumors (GIST) are potentially malignant tumors and require evidence-based surgical and/or medical treatment. Laparoscopy has similar safety and prognostic outcomes to those of laparotomy and is currently a standard procedure for localized GISTs. However, surgery for gastric GISTs less than 2 cm may be re-evaluated due to the indolent nature of the GIST and other competing risks among GIST patients. A work-up with endoscopy and endoscopic ultrasonography as well as endoscopic or percutaneous biopsy is important for the preoperative diagnosis of GISTs. Medical treatment with tyrosine kinase inhibitors is the mainstay for recurrent/metastatic GISTs. The activity of an individual drug is well correlated with gene alterations, and, in the era of precision medicine, cancer genome profiling should be considered before medical treatment.Gastrointestinal stromal tumors (GISTs) are the most frequent malignant mesenchymal tumors in the gastrointestinal tract. The clinical incidence of GISTs is estimated 10/million/year; however, the true incidence is complicated by frequent findings of tiny GISTs, of which the natural history is unknown. The initial work-up with endoscopy and endoscopic ultrasonography plays important roles in the differential diagnosis of GISTs. Surgery is the only modality for the permanent cure of localized GISTs. In terms of safety and prognostic outcomes, laparoscopy is similar to laparotomy for GIST treatment, including tumors larger than 5 cm. GIST progression is driven by mutations in KIT or PDGFRA or by other rare gene alterations, all of which are mutually exclusive. Tyrosine kinase inhibitors (TKIs) are the standard therapy for metastatic/recurrent GISTs. Molecular alterations are the most reliable biomarkers for TKIs and for other drugs, such as NTRK inhibitors. The pathological and genetic diagnosis prior to treatment has been challenging; however, a newly developed endoscopic device may be useful for diagnosis. In the era of precision medicine, cancer genome profiling by targeted gene panel analysis may enable potential targeted therapy even for GISTs without KIT or PDGFRA mutations.
Highlights
The gastrointestinal stromal tumor (GIST) is a potentially malignant mesenchymal tumor that usually expresses KIT or DOG1 proteins by immunohistochemistry (IHC)
Gastric GIST is frequently found by endoscopy and/or fluoroscopy; the initial work-up with endoscopy and endoscopic ultrasonography (EUS) is important in the differential diagnosis of GISTs from other neoplastic submucosal tumors (SMTs)
Metastatic/recurrent GISTs with conventional KIT or PDGFRA mutations stabilized in the autoinhibited form (Table 1 and Figure 1) are initially treated with imatinib, and when resistance or intolerance to imatinib develops, sunitinib serves as the second-line treatment
Summary
The gastrointestinal stromal tumor (GIST) is a potentially malignant mesenchymal tumor (sarcoma) that usually expresses KIT or DOG1 proteins by immunohistochemistry (IHC). 15%) may have other mutations in BRAF, RAS family genes, and NF1, and alterations in the SDH (succinate dehydrogenase; complex III in the mitochondrial electron transport system) complex or in NRTK translocation (Table 1) [4,5,6,7,8,9,10,11] These mutations and alterations are mutually exclusive in primary GISTs. The incidence of clinical GISTs, symptomatic GISTs or GISTs requiring treatment, is assumed to be 6–22 cases per million per year [1,2,3,4]. D842V is sensitive to avapritinib & ripretinib possibly sensitive to MEK inhibitors, such as selumetinib not sensitive to available drugs possibly sensitive to BRAF inhibitors (e.g., vemurafenib, dabrafenib) not sensitive to available drugs
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