Conley Anthony Paul, Guerin Annie, Sasane Medha, Gauthier Genevieve, Schwiep Frances, Keir Christopher Hunt, Wu Eric Q
Department of Sarcoma Medical Oncology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 450, Houston, TX, 77030, USA,
J Gastrointest Cancer. 2014 Dec;45(4):431-40. doi: 10.1007/s12029-014-9600-4.
The aim of this study was to investigate tumor characteristics, treatment patterns, and outcomes in recurrent KIT + GIST patients treated in a community practice setting.
An online tool was used to retrieve data on 410 patients treated with adjuvant imatinib mesylate (IM) for primary resectable KIT + GIST, who discontinued, had a recurrence, and then restarted IM or initiated sunitinib. Tumor characteristics at recurrence, treatment patterns, and factors associated with post-recurrence complete response (CR) achievement were analyzed.
About 72.7 % of patients did not have surgery post-recurrence as majority of them had unresectable (45 %), metastatic (40 %), or multifocal tumors (62.4 %). Following recurrence, 76.6 % of patients were re-started on IM and 23.4 % on sunitinib; patients were 7.37 times more likely to re-start IM if initial treatment duration was ≤18 months (p < 0.001). Patients were also more likely to re-start IM if recurrence occurred >12 months post-discontinuation, or they had a recurrence inside the GI system, lower or unknown Fletcher risk score at primary diagnosis, or lower mitotic rate, (odds ratio (OR) = 3.54, p < 0.001; OR = 2.64, p = 0.006; OR = 2.55, p = 0.007; and OR = 2.45, p = 0.002, respectively). About 22.4 % achieved CR; patients were more likely to achieve CR if they had unifocal tumor at recurrence, inside the GI system, of ≤2 cm, or had lower mitotic rate (OR = 2.61, p < 0.001; OR = 2.27, p = 0.036; OR = 2.16, p = 0.023, OR = 1.87, p = 0.017, respectively).
IM treatment duration at primary diagnosis, time to develop recurrence after IM discontinuation, tumor location, and mitotic rate at recurrence were the main prescribing decision drivers. Tumor characteristics were the most important factor in achieving CR following c-KIT inhibitor retreatment.
本研究旨在调查在社区实践环境中接受治疗的复发KIT+胃肠道间质瘤（GIST）患者的肿瘤特征、治疗模式及治疗结果。
使用在线工具检索410例接受甲磺酸伊马替尼（IM）辅助治疗的原发性可切除KIT+GIST患者的数据，这些患者停药后复发，随后重新开始使用IM或开始使用舒尼替尼。分析复发时的肿瘤特征、治疗模式以及与复发后实现完全缓解（CR）相关的因素。
约72.7%的患者复发后未接受手术，因为大多数患者有不可切除的肿瘤（45%）、转移性肿瘤（40%）或多灶性肿瘤（62.4%）。复发后，76.6%的患者重新开始使用IM，23.4%的患者开始使用舒尼替尼；如果初始治疗持续时间≤18个月，患者重新开始使用IM的可能性高7.37倍（p<0.001）。如果在停药>12个月后复发，或者复发发生在胃肠道系统内，或者在初次诊断时Fletcher风险评分较低或未知，或者有较低的有丝分裂率，患者也更有可能重新开始使用IM（优势比（OR）分别为3.54，p<0.001；OR=2.64，p=0.006；OR=2.55，p=0.007；OR=2.45，p=0.002）。约22.4%的患者实现了CR；如果复发时肿瘤为单灶性、位于胃肠道系统内、直径≤2 cm或有较低的有丝分裂率，患者更有可能实现CR（OR分别为2.61，p<0.001；OR=2.27，p=0.036；OR=2.16，p=0.023；OR=1.87，p=0.017）。
初次诊断时的IM治疗持续时间、IM停药后复发的时间、肿瘤位置以及复发时的有丝分裂率是主要的处方决策驱动因素。肿瘤特征是c-KIT抑制剂再治疗后实现CR的最重要因素。
