The challenge of opportunities: how far can and should we go with targeted treatments and modern diagnostics in gastrointestinal stromal tumors?

摘要

The introduction of imatinib has greatly improved the treatment options and quality of life of patients with gastrointestinal stromal tumors. Systemic treatment with imatinib alone most likely, however, does not cure the disease because, despite long-lasting major remissions, the majority of patients eventually relapse. Therefore, complete surgical resection remains the only curative approach in patients with gastrointestinal stromal tumors. Given a strong systemic treatment option at hand, the use of multimodal treatment strategies for patients with locally advanced or metastatic disease seems self-evident as many tumors become resectable after a treatment with imatinib. Few retrospective and no prospective data, however, are yet available on feasibility and the prognostic impact of these strategies, which represents a major challenge on how to decide on these patients in clinical practice. We therefore critically discuss the available evidence and current concepts for multimodal treatment of gastrointestinal stromal tumors and how modern diagnostics, such as KIT genotyping, may influence our clinical decision-making in this context.