Current issues in gastrointestinal stromal tumors: incidence, molecular biology, and contemporary treatment of localized and advanced disease.

摘要

PURPOSE OF REVIEW: Few areas in oncology have witnessed the major paradigm shift that has been noted in the understanding and management of gastrointestinal stromal tumors. This review highlights the progress made over the last 2 years. RECENT FINDINGS: Population-based studies have provided insight into the true incidence of gastrointestinal stromal tumors. Improved understanding of the molecular biology has provided prognostic implications and may guide treatment in the future. More mature follow-up data from phase III trials have proven that the targeted tyrosine kinase inhibitor imatinib mesylate is a dramatically effective agent, but the duration of its benefits are finite, and drug resistance is an increasingly more common phenomenon. Adjuvant and neoadjuvant trials of imatinib are currently underway. A second targeted tyrosine kinase inhibitor, sunitinib malate, has been approved for the treatment of imatinib-resistant gastrointestinal stromal tumors after recent encouraging results. Finally, the success with imatinib and sunitinib has encouraged investigators to reevaluate the role of surgery in advanced gastrointestinal stromal tumors. SUMMARY: The multidisciplinary management of gastrointestinal stromal tumors serves as a model of how new targeted molecular therapies can be combined with traditional treatment modalities to improve survival in advanced malignancies.