Combined surgical and molecular therapy: The gastrointestinal stromal tumor model Journal Article
| Authors: | Gold, J. S.; DeMatteo, R. P. |
| Article Title: | Combined surgical and molecular therapy: The gastrointestinal stromal tumor model |
| Abstract: | OBJECTIVE: This review describes the pathologic and epidemiologic features of gastrointestinal stromal tumor (GIST) as well as the contemporary management of this tumor. The integration of surgery and treatment with targeted molecular agents in the treatment of GIST is highlighted. SUMMARY BACKGROUND DATA: GIST is the most common mesenchymal tumor of the gastrointestinal tract. Its cellular origin from the interstitial cell of Cajal and distinctness from smooth muscles tumors were only recently appreciated. The discovery of the centrality of KIT proto-oncogene mutations in the pathogenesis of this tumor, and the development of imatinib mesylate, a specific inhibitor of KIT tyrosine kinase function have revolutionized the treatment of GIST. METHODS: We conducted a review of the English literature on GIST. The pathology, epidemiology, diagnosis, and treatment of this tumor are summarized with particular emphasis on recent developments in the field. RESULTS: GIST is a rare tumor that usually arises from the stomach or small intestine. It is characterized by immunohistochemical staining for KIT. Treatment of primary localized tumors is surgical. The benefit of adjuvant treatment with the KIT tyrosine kinase inhibitor imatinib is the subject of investigation. The treatment of unresectable, recurrent, or metastatic GIST is primarily imatinib treatment. The integration of surgery or ablative modalities is often employed, particularly when all disease is amenable to gross resection or destruction, or when GIST becomes resistant to imatinib. Newer tyrosine kinase inhibitors, such as sunitinib are the subject of ongoing investigation. CONCLUSIONS: The treatment paradigm for GIST has required the integration of surgery and molecular therapy and this will likely serve as a paradigm for the treatment of other solid tumors as targeted agents are developed. Copyright © 2006 by Lippincott Williams & Wilkins. |
| Keywords: | immunohistochemistry; treatment outcome; treatment response; cancer surgery; unclassified drug; gene mutation; clinical trial; fatigue; review; cancer recurrence; bevacizumab; doxorubicin; sunitinib; artificial embolism; cancer risk; diarrhea; drug efficacy; drug safety; drug withdrawal; multimodality cancer therapy; solid tumor; treatment duration; treatment planning; antineoplastic agents; drug targeting; cancer adjuvant therapy; neoadjuvant therapy; recurrent cancer; cancer diagnosis; gastrointestinal stromal tumor; imatinib; stem cell factor; tumor localization; gastrointestinal stromal tumors; proto-oncogene proteins c-kit; metastasis; drug eruption; nausea; clinical assessment; molecular dynamics; drug effect; pathology; chronic myeloid leukemia; pyrimidines; cancer research; cancer therapy; carcinogenesis; cancer resistance; protein tyrosine kinase inhibitor; abdominal pain; protein kinase inhibitors; gastrointestinal neoplasms; patient care; liver metastasis; drug research; drug mechanism; liver resection; medical literature; tumor model; protein-tyrosine kinases; cancer epidemiology; piperazines; periorbital edema; radiofrequency ablation; small intestine; dose calculation; everolimus; phosphotransferase inhibitor; hepatic artery; stomach; clinical observation; rare disease; muscle cramp; midostaurin; n (3,3 dimethyl 6 indolinyl) 2 (4 pyridinylmethylamino)nicotinamide |
| Journal Title: | Annals of Surgery |
| Volume: | 244 |
| Issue: | 2 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2006-08-01 |
| Start Page: | 176 |
| End Page: | 184 |
| Language: | English |
| DOI: | 10.1097/01.sla.0000218080.94145.cf |
| PUBMED: | 16858179 |
| PROVIDER: | scopus |
| PMCID: | PMC1602162 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 113" - "Export Date: 4 June 2012" - "CODEN: ANSUA" - "Source: Scopus" |
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