Department of Sarcoma Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
Curr Opin Oncol. 2010 Jul;22(4):330-5. doi: 10.1097/CCO.0b013e32833aaaad.
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and is a paradigm of targeted therapy for solid tumors. Elucidation of the biology of GIST enabled use of imatinib, which revolutionized the prognosis of advanced GIST. Whereas surgical resection continues to be the standard of care for primary GIST, judicious and individualized use of adjuvant and neoadjuvant imatinib may enhance the potential for cure in select patients.
Prospective trials utilizing adjuvant and neoadjuvant imatinib have established the safety and efficacy of these modalities adjunct to surgical resection. Correlative tissue studies derived from these trials have examined gene expression patterns, metabolic and radiographic response, and apoptosis during the first few days of imatinib therapy. As appropriate use of adjuvant and neoadjuvant imatinib requires proper patient selection, development of a predictive nomogram, and advances in mutational analysis represent progress toward individualized care.
Imatinib is well tolerated and beneficial as adjuvant and neoadjuvant therapy, but its utility in these settings continues to be refined. The greatest benefit will derive from an individualized approach that considers multiple patient, drug, and tumor characteristics to assess risk and likelihood of benefit for each patient.
胃肠道间质瘤（GIST）是胃肠道最常见的间叶性肿瘤，是实体瘤靶向治疗的典范。GIST 生物学的阐明使伊马替尼得以应用，从而彻底改变了晚期 GIST 的预后。虽然手术切除仍然是 GIST 初始治疗的标准方法，但在选择患者时，合理和个体化地使用辅助和新辅助伊马替尼可能会提高治愈的可能性。
利用辅助和新辅助伊马替尼的前瞻性试验已经证实了这些方法联合手术切除的安全性和有效性。来自这些试验的相关组织研究检查了伊马替尼治疗最初几天的基因表达模式、代谢和影像学反应以及细胞凋亡。由于辅助和新辅助伊马替尼的适当使用需要适当的患者选择、预测列线图的开发以及突变分析的进展，代表了朝着个体化护理的进展。
伊马替尼作为辅助和新辅助治疗具有良好的耐受性和益处，但它在这些情况下的应用仍在不断完善。最大的益处将来自于一种个体化的方法，该方法考虑了多种患者、药物和肿瘤特征，以评估每个患者的风险和获益可能性。
