Adjuvant imatinib in GIST: a self-fulfilling prophecy, or more?

摘要

Gastrointestinal stromal tumour (GIST) has become a model for targeted treatment of solid tumours. A small-molecule tyrosine-kinase inhibitor (imatinib mesylate) is the standard first-line treatment in the advanced disease. In The Lancet today, Ronald DeMatteo and colleagues2 report a randomised trial with imatinib administered alone as an adjuvant therapy after RO resection of the primary tumour to improve outcome in this orphan disease. The situation is different from adjuvant treatment in breast cancer, for example, which has more than 30 years of studies and thousands of women in trials. However, by contrast with breast cancer, we know that more than 80% of patients with GIST carry an oncogenic mutation in KIT, a class III tyrosine kinase. Imatinib stops autophosphorylation of the receptor and thus halts tumour proliferation.