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Annals of Oncology 2009 20(Supplement 1):i18-i24; doi:10.1093/annonc/mdp075
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

This article appears in the following Annals of Oncology issue: Expanding the boundaries of clinical practice: building on experience with targeted therapies 12 September 2008, Stockholm, Sweden [View the issue table of contents]

symposium articles

New paradigms in gastrointestinal stromal tumour management

J.-Y. Blay

Cytokine and Cancer Unit, Léon Bérard Cancer Centre, Lyon, France

Correspondence to: Jean-Yves Blay, Cytokine and Cancer Unit, Léon Bérard Cancer Centre, 28 rue Laennec, 69008 Lyon, France. Tel: +33-4-78-78-51-09; Fax: +33-4-78-78-27-16; E-mail: blay{at}lyon.fnclcc.fr

Background: Targeted agents have improved the prognosis for patients with advanced gastrointestinal stromal tumours (GISTs). Many patients exhibit intolerance or resistance to first-line therapy with imatinib mesylate. Sunitinib malate is approved multinationally for the treatment of advanced imatinib-refractory GIST.

Design: This article reviews responses to imatinib and sunitinib reported in clinical trials in advanced GIST and discusses the effect of mutational status on treatment responses; therapeutic developments in GIST treatment are also reviewed.

Results: Imatinib 400 mg/day has shown efficacy for first-line treatment of advanced GIST, particularly in patients with KIT exon 11 mutations. Sunitinib 50 mg/day (Schedule 4/2) has demonstrated effectiveness and tolerability in imatinib-refractory GIST, including patients who would be excluded from clinical trials. Sunitinib is associated with longer median overall survival in patients with primary KIT exon 9 mutations and wild-type GIST compared with KIT exon 11 mutations in a retrospective study. Ongoing studies, including imatinib in the adjuvant setting and the use of targeted agents in sequence or in combination, will further refine the therapeutic pathway for advanced GIST.

Conclusions: The availability of targeted therapies and greater knowledge of the effect of mutational status on patient responses will assist in optimising outcomes in advanced GIST.

Key words: gastrointestinal stromal tumour, imatinib mesylate, mutational status, sunitinib malate, treatment resistance


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C. N. Sternberg
Expanding the boundaries of clinical practice: building on experience with targeted therapies
Ann. Onc., May 1, 2009; 20(suppl_1): i1 - i6.
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