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Annals of Surgical Oncology

, Volume 19, Issue 5, pp 1551–1559 | Cite as

Patterns of Care, Prognosis, and Survival in Patients with Metastatic Gastrointestinal Stromal Tumors (GIST) Refractory to First-Line Imatinib and Second-Line Sunitinib

  • Antoine ItalianoEmail author
  • Angela Cioffi
  • Paola Coco
  • Robert G. Maki
  • Patrick Schöffski
  • Piotr Rutkowski
  • Axel Le Cesne
  • Florence Duffaud
  • Antoine Adenis
  • Nicolas Isambert
  • Emmanuelle Bompas
  • Jean-Yves Blay
  • Paolo Casali
  • Mary Louise Keohan
  • Maud Toulmonde
  • Cristina R. Antonescu
  • Maria Debiec-Rychter
  • Jean-Michel Coindre
  • Binh Bui
Gastrointestinal Oncology

Abstract

Background

Data regarding the management and outcome of patients with metastatic gastrointestinal stromal tumors (GIST) refractory to 1st-line imatinib and 2nd-line sunitinib are limited.

Methods

Medical records of 223 imatinib-resistant and sunitinib-resistant GIST who were treated in 11 major referral centers were reviewed.

Results

The three most frequent drugs used in the 3rd-line setting were: nilotinib n = 67 (29.5%), sorafenib n = 55 (24.5%), and imatinib n = 40 (17.5%). There were 18 patients (8%) who received best supportive care (BSC) only. The median progression-free survival (PFS) and overall survival (OS) on 3rd-line treatment were 3.6 months [95% confidence interval (95% CI), 3.1–4.1] and 9.2 months (95% CI, 7.5–10.9), respectively. Multivariate analysis showed that, in the 3rd-line setting, albumin level and KIT/PDGFRA mutational status were significantly associated with PFS, whereas performance status and albumin level were associated with OS. After adjustment for prognostic factors, nilotinib and sorafenib provided the best PFS and OS. Rechallenge with imatinib was also associated with improved OS in comparison with BSC.

Conclusion

In the 3rd-line setting, rechallenge with imatinib provided limited clinical benefit but was superior to BSC. Sorafenib and nilotinib have significant clinical activity in imatinib-resistant and sunitinib-resistant GIST and may represent an alternative for rechallenge with imatinib.

Keywords

Overall Survival Imatinib Sorafenib Sunitinib Median Overall Survival 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Antoine Italiano
    • 1
    • 2
    Email author
  • Angela Cioffi
    • 2
    • 3
  • Paola Coco
    • 4
  • Robert G. Maki
    • 2
    • 5
  • Patrick Schöffski
    • 6
  • Piotr Rutkowski
    • 7
  • Axel Le Cesne
    • 3
  • Florence Duffaud
    • 8
  • Antoine Adenis
    • 9
  • Nicolas Isambert
    • 10
  • Emmanuelle Bompas
    • 11
  • Jean-Yves Blay
    • 12
  • Paolo Casali
    • 3
  • Mary Louise Keohan
    • 2
  • Maud Toulmonde
    • 1
  • Cristina R. Antonescu
    • 2
  • Maria Debiec-Rychter
    • 13
  • Jean-Michel Coindre
    • 1
  • Binh Bui
    • 1
  1. 1.Institut BergoniéBordeauxFrance
  2. 2.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Institut Gustave RoussyVillejuifFrance
  4. 4.Istituto dei TumoriMilanItaly
  5. 5.Department of Medicine/PediatricsMount Sinai School of MedicineNew YorkUSA
  6. 6.Department of General Medical Oncology and Laboratory of Experimental OncologyUniversity Hospitals Leuven, Leuven Cancer Institute, Catholic University LeuvenLeuvenBelgium
  7. 7.Sklodowska-Curie Memorial Cancer Center and Institute of OncologyWarsawPoland
  8. 8.Hôpital La TimoneMarseilleFrance
  9. 9.Centre Oscar LambretLilleFrance
  10. 10.Centre Georges François LeclercDijonFrance
  11. 11.Centre René GauducheauNantesFrance
  12. 12.Centre Léon BérardLyonFrance
  13. 13.Department of Human GeneticsUniversity Hospital LeuvenLeuvenBelgium

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