Presentation on theme: "Major sites of GIST metastases:"— Presentation transcript:
1 Major sites of GIST metastases: GIST: Clinical PresentationGIST may occur anywhere along the GI tract or elsewhere in the abdomen or retroperitoneumEsophagus (2%)Colon/Rectum (5%)Other (mesentery, retroperitoneum)8%Major sites of GIST metastases:liverperitoneumbonelung25%Smallintestine60%StomachAdapted from: Corless et al. J Clin Oncol 2004;22:
2 GIST Evaluation Factors for Consideration GIST histologic type (spindle/epithelioid/mixed)KIT-positive/-negativeBiologic risk potential (low/intermediate/high)Tumour size and location (1 section/1 cm tumour)Cellularity (low/moderate/high), cellular atypia (mild/moderate/marked)Mitotic count/50 HPFTumour necrosisMucosal ulcerationLympho-vascular invasionMargin statusAdapted from Marginean C. GIST Consensus Meeting 2007, Ottawa.
4 GIST ImagingCTDelineates the large exophytic masses and local and distant metastasesGuides tissue biopsyPETDifferentiates tissues and assesses tumor metabolic activityFor early treatment-response evaluationLarge heterogeneous duodenal GIST (D)with multifocal hepatic metastases (M).The biliary tree and pancreatic duct are not dilated.Image reprinted with permission from Lau et al. Clin Radiol 2004;59:
5 Primary GIST: Risk Factors for Recurrence After Surgery Rates of RFS were predicted bymitotic index and tumour size0.250.500.751.020406080Months3 mitoses/30 HPF>3 to 15 mitoses/30 HPF>15 mitoses/30 HPFP=0.0001Recurrence-free survivalMitotic index0.250.500.751.020406080<5 cm5-10 cm>10 cmP=0.03MonthsRecurrence-free survivalTumour sizeSinger et al. J Clin Oncol 2002;20:Adapted with permission from ASCO.
6 ACOSOG Z9001 Study: Relapse Events at One Year The ACOSOG Z9001 Study, which randomized 644 patients to a TK inhibitor or placeboafter GIST surgical resection, was halted early when the relapse rate was 67.5% lowerat one year in the arm receiving the TK inhibitor (hazard ratio=0.325;P= foractive treatment vs. placebo).Adapted from: DeMatteo et al. ASCO 2007, Abs
7 Treatment Algorithm for Patients with Primary Metastatic or Recurrent GIST Primary diseaseRecurrent diseaseNo metastasisMetastasis or unresectableImatinibSurgeryResponse or stable diseaseProgressionPost-operative imatinib (adjuvant)Under clinical investigation:- Nilotinib - RAD001 - PKC412Sunitinib or surgery?Surgery?Adapted from van der Zwan SM, DeMatteo RP. Cancer 2005;104: