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Medical Oncology

, Volume 27, Issue 2, pp 213–218 | Cite as

Analysis of a case with disappearance of the primary gastrointestinal stromal tumor and progressive liver metastases under long-term treatment with tyrosine kinase inhibitors

  • Silke Cameron
  • Theodoros Savvoukidis
  • Thomas Armbrust
  • Florian Haller
  • Julia Kitz
  • László Füzesi
  • Giuliano RamadoriEmail author
Original Paper

Abstract

The response of gastrointestinal stromal tumors (GISTs) to tyrosine kinase receptor inhibitors (TKR-I) has been a breakthrough for small molecular therapy. We report here on the very different long-term outcome of a synchronous metastatic GIST with complete remission of the primary tumor and progressive liver metastases under TKR-I therapy. In 2003, a 52-year-old patient was diagnosed with gastric GIST and synchronous multiple liver metastases. Therapy with imatinib, 400 mg daily, was started immediately. Fifteen months later, the primary was no longer detectable by endoscopy. In 2006, progression of the liver metastases was observed. Mutation analysis of the initial biopsy specimen from the primary, as well as the biopsy from the three main liver metastases after 3 years of imatinib treatment, revealed the common KIT exon 11 deletion (W557_K558del) in all tumor samples. Two of the metastases had a separate secondary mutation in KIT exon 14 and 17, respectively, while the largest cystic metastatic lesion had no other mutation. Imatinib was then increased to a daily dose of 800 mg, and in April 2007 the treatment was changed to sunitinib. Fifty-two months after initial diagnosis, the patient died of liver failure. At no time point, relapse of the gastric primary tumor was observed. Whilst TKR-Is are commonly very effective in treating GISTs, the present case illustrates their varying effects regarding the clinical behavior and genetic variations within different tumors of the same patient after long-term treatment.

Keywords

Gastrointestinal stromal tumor (GIST) Secondary mutations Mutation analysis Tyrosine kinase receptor inhibitor (TKR-I) Treatment response of primary GIST versus metastases 

Notes

Acknowledgment

We are thankful to all our colleagues who participated in the treatment of the patient.

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Copyright information

© Humana Press Inc. 2009

Authors and Affiliations

  • Silke Cameron
    • 1
  • Theodoros Savvoukidis
    • 1
  • Thomas Armbrust
    • 1
  • Florian Haller
    • 2
  • Julia Kitz
    • 2
  • László Füzesi
    • 2
  • Giuliano Ramadori
    • 1
    Email author
  1. 1.Department of Gastroenterology and EndocrinologyUniversity Clinic of GöttingenGöttingenGermany
  2. 2.Department of GastroenteropathologyUniversity Clinic of the Georg August UniversityGöttingenGermany

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