Chiang Kun-Chun, Chen Tsung-Wen, Yeh Chun-Nan, Liu Feng-Yuan, Lee Hsiang-Lin, Jan Yi-Yin
Department of Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Taoyuan, Taiwan, China.
World J Gastroenterol. 2006 Apr 7;12(13):2060-4. doi: 10.3748/wjg.v12.i13.2060.
Most gastrointestinal stromal tumors (GISTs) express constitutively activated mutant isoforms of kit kinase or platelet-derived growth factor receptor alpha (PDGFRA), which are potential therapeutic targets for imatinib mesylate (Glivec). Partial response occurred in almost two thirds of GIST patients treated with Glivec. However, complete response (CR) after Glivec therapy was sporadically reported. Here we illustrated advanced GIST patients with CR after Glivec treatment.
Between January 2001 and June 2005, 42 advanced GIST patients were treated with Glivec. Patients were administered 400 mg of Glivec in 100-mg capsules, taken orally daily with food. The response of the tumor to Glivec was evaluated after one month, three months, and every three months thereafter or whenever medical need was indicated. Each tumor of patients was investigated for mutations of kit or PDGFRA.
The median follow-up time of the 42 advanced GIST patients treated with Glivec was 16.9 months (range, 1.0-47.0 months). Overall, 3 patients had complete response CR (7.1%), 26 partial response (67.8%), 5 stationary disease (11.9%), and 3 progressive disease (11.9%). The median duration of Glivec administration for the three patients was 36 months (range, 23-36 months). The median time to CR after Glivec treatment was 20 months (range, 9-26 months). Deletion and insertion mutations of c-kit exon 11 and insertion mutation of c-kit exon 9 were found in two cases and one case, respectively.
Complete response (CR) can be achi-eved in selected advanced GIST patients treated with Glivec. The median time to CR after Glivec treatment was 20 months. Deletion and insertion mutations of kit exon 11 and insertion mutation of kit exon 9 contribute to the genetic features in these selected cases.
大多数胃肠道间质瘤（GISTs）表达组成型激活的kit激酶或血小板衍生生长因子受体α（PDGFRA）突变异构体，它们是甲磺酸伊马替尼（格列卫）的潜在治疗靶点。接受格列卫治疗的GIST患者中近三分之二出现部分缓解。然而，格列卫治疗后的完全缓解（CR）报告较少。在此，我们阐述了接受格列卫治疗后达到CR的晚期GIST患者。
2001年1月至2005年6月，42例晚期GIST患者接受格列卫治疗。患者口服100mg胶囊剂型的格列卫400mg，每日随餐服用。治疗1个月、3个月后，此后每3个月或根据医疗需要评估肿瘤对格列卫的反应。对患者的每个肿瘤进行kit或PDGFRA突变检测。
42例接受格列卫治疗的晚期GIST患者的中位随访时间为16.9个月（范围1.0 - 47.0个月）。总体而言，3例患者达到完全缓解（CR，7.1%），26例部分缓解（67.8%），5例病情稳定（11.9%），3例病情进展（11.9%）。这3例患者格列卫给药的中位持续时间为36个月（范围23 - 36个月）。格列卫治疗后达到CR的中位时间为20个月（范围9 - 26个月）。分别在2例和1例患者中发现了c-kit外显子11的缺失和插入突变以及c-kit外显子9的插入突变。
在接受格列卫治疗的部分晚期GIST患者中可实现完全缓解（CR）。格列卫治疗后达到CR的中位时间为20个月。kit外显子11的缺失和插入突变以及kit外显子9的插入突变是这些特定病例的遗传特征。
