Eisenberg Burton L
Dartmouth-Hitchcock Medical Center, Norris Cotton Cancer Center, Lebanon, NH 03756, USA.
Semin Oncol. 2006 Dec;33(6 Suppl 11):S75-8. doi: 10.1053/j.seminoncol.2006.10.017.
Gastrointestinal stromal tumor (GIST) is the most common nonepithelial tumor of the gastrointestinal tract. The majority of these tumors stain positive for the CD117 antigen to the KIT protein and have become a well-documented clinical entity. The dysregulated KIT protein is oncogenic and is an ideal target for imatinib, a KIT-selective inhibitor. Clinical trials of imatinib for metastatic GIST have shown either partial response or long-duration stable disease in 82% of patients. Trials addressing the efficacy of adjuvant imatinib following resection for high-risk primary GIST are awaiting results. The neoadjuvant preoperative use of imatinib to provide pharmacologic debulking and long-term disease control is also nearing completion in a clinical trial. This trial has the potential of addressing whether the combination of surgery and imatinib can enhance organ sparing, decrease drug resistance, and prolong disease-free and overall survival. The continued study of combining surgery and a target-specific agent for malignant GIST will be a valuable reference for future strategies combining surgery and targeted treatment in other solid tumors.
胃肠道间质瘤（GIST）是胃肠道最常见的非上皮性肿瘤。这些肿瘤大多数对KIT蛋白的CD117抗原染色呈阳性，已成为一个有充分文献记载的临床实体。失调的KIT蛋白具有致癌性，是伊马替尼（一种KIT选择性抑制剂）的理想靶点。伊马替尼治疗转移性GIST的临床试验显示，82%的患者出现部分缓解或疾病长期稳定。针对高危原发性GIST切除术后辅助使用伊马替尼疗效的试验正在等待结果。伊马替尼新辅助术前用药以实现药物减瘤和长期疾病控制的临床试验也即将完成。该试验有可能探讨手术与伊马替尼联合应用是否能提高器官保留率、降低耐药性以及延长无病生存期和总生存期。对恶性GIST联合手术与靶向特异性药物的持续研究将为未来其他实体瘤联合手术与靶向治疗的策略提供有价值的参考。
