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Analysis of Prognostic Factors Impacting Oncologic Outcomes After Neoadjuvant Tyrosine Kinase Inhibitor Therapy for Gastrointestinal Stromal Tumors

  • Bone and Soft Tissue Sarcomas
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Management of gastrointestinal stromal tumors (GISTs) has been transformed with tyrosine kinase inhibitors (TKIs). While data on optimal duration of adjuvant imatinib remains elusive, guidelines for administration of neoadjuvant TKIs remain unknown.

Methods

Under an institutional review board-approved protocol, patients at our institution with a diagnosis of GIST treated with neoadjuvant TKIs and surgical resection were identified. Clinical and pathologic characteristics were obtained from medical records.

Results

Ninety-three patients underwent surgical resection after neoadjuvant TKI therapy; 41 had primary and 52 had recurrent/metastatic GIST. Median follow-up was 2.4 years. Median duration of neoadjuvant therapy was 315 (range 3–1,611) days for primary and 537 (range 4–3,257) days for recurrent/metastatic GIST (p = 0.001). Two-year, recurrence-free survival (RFS) was 85 and 44 % for primary and recurrent/metastatic disease, respectively, whereas 2-year overall survival (OS) was 97 % for primary and 73 % for recurrent/metastatic GIST. For primary GIST, duration of neoadjuvant therapy >365 days (p = 0.02) was associated with higher risk of recurrence on univariate analysis, whereas none of the clinicopathologic factors impacted OS. For recurrent/metastatic disease, disease progression was associated with a shorter OS (p = 0.001), but no factors were found to impact RFS. Lastly, when examining all patients, KIT mutations (p = 0.03) and multivisceral resection (p = 0.011) predicted shorter RFS.

Conclusions

Neoadjuvant TKIs can be effectively used for the treatment of primary and recurrent/metastatic GIST. While duration of neoadjuvant therapy, KIT mutation status, and the need for multivisceral resection can help to predict higher risk for recurrence, progression on neoadjuvant TKIs can aid in selection of patients with recurrent/metastatic disease for surgical resection.

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Conflict of interest

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Brian K. Bednarski MD, Min Yi MD, PhD, Keila E. Torres MD, PhD, Janice N. Cormier MD, MPH, Peter W. T. Pisters MD, Barry W. Feig MD & Kelly K. Hunt MD

  2. Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Dejka M. Araujo MD

  3. Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Alexander Lazar MD, PhD

  4. Department of Cancer Biology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Dina Chelouche Lev MD

  5. Department of Medicine, The University of Miami, Miami, FL, USA

    Jonathan C. Trent MD, PhD

  6. Department of Surgical Oncology, The Ohio State University, Columbus, OH, USA

    Raphael E. Pollock MD, PhD

Authors
  1. Brian K. Bednarski MD
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  2. Dejka M. Araujo MD
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  3. Min Yi MD, PhD
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  4. Keila E. Torres MD, PhD
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  5. Alexander Lazar MD, PhD
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  6. Jonathan C. Trent MD, PhD
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  7. Janice N. Cormier MD, MPH
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  8. Peter W. T. Pisters MD
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  9. Dina Chelouche Lev MD
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  10. Raphael E. Pollock MD, PhD
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  11. Barry W. Feig MD
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  12. Kelly K. Hunt MD
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Corresponding author

Correspondence to Kelly K. Hunt MD.

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Bednarski, B.K., Araujo, D.M., Yi, M. et al. Analysis of Prognostic Factors Impacting Oncologic Outcomes After Neoadjuvant Tyrosine Kinase Inhibitor Therapy for Gastrointestinal Stromal Tumors. Ann Surg Oncol 21, 2499–2505 (2014). https://doi.org/10.1245/s10434-014-3632-7

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  • DOI: https://doi.org/10.1245/s10434-014-3632-7

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