Gastrointestinal Stromal Tumor Team, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, R.O.C.
Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan, R.O.C.
Anticancer Res. 2014 Sep;34(9):5029-36.
Imatinib mesylate (IM) is effective in metastatic gastrointestinal stromal tumor (GIST) patients; however, disease progression eventually occurs due to IM resistance or intolerance. Treatment options include IM escalation or a direct shift to sunitinib, but comparison of these strategies is required.
This study included 91 out of 214 metastatic GIST patients treated with IM, who experienced progression or intolerance between August 2001 and December 2012 at the Chang Gung Memorial Hospital. Treatment efficacy and safety profiles were retrospectively compared between groups of patients who either received escalated IM or were directly switched to sunitinib.
There were no significant differences in age, gender, second-line treatment causes or gene mutations in the IM escalation group (N=63) versus the sunitinib group (N=28). The 2 groups had similar progression-free survival (PFS, p=0.316) and overall survival (OS, p=0.599). Patients without primary KIT exon 9 mutations and who treated with sunitinib had significantly better PFS (14.3 vs. 6.2 months, p=0.037) and a trend toward better OS (not reached vs. 16.4 months, p=0.161) compared to the IM-escalation group. Patients in both groups with responses and stable disease (SD), and IM escalation patients who underwent surgery and who had KIT exon 9 mutations, had favorable PFS. The most common non-hematological adverse events were edema in the IM escalation group and hand-foot syndrome and hypertension in the sunitinib group.
Comparable results were achieved by IM escalation and sunitinib treatment. Physicians should consider kinase mutations and specific adverse effects when choosing between these treatments.
甲磺酸伊马替尼（IM）对转移性胃肠道间质瘤（GIST）患者有效；然而，由于 IM 耐药或不耐受，疾病最终会进展。治疗选择包括 IM 升级或直接转为舒尼替尼，但需要比较这些策略。
这项研究包括 214 例转移性 GIST 患者中的 91 例，他们在 2001 年 8 月至 2012 年 12 月期间在长庚纪念医院接受 IM 治疗，出现进展或不耐受。回顾性比较了接受 IM 升级或直接转为舒尼替尼的两组患者的治疗效果和安全性。
IM 升级组（N=63）与舒尼替尼组（N=28）在年龄、性别、二线治疗原因或基因突变方面无显著差异。两组患者的无进展生存期（PFS，p=0.316）和总生存期（OS，p=0.599）相似。未发生原发性 KIT 外显子 9 突变且接受舒尼替尼治疗的患者 PFS 显著改善（14.3 对 6.2 个月，p=0.037），OS 也有改善趋势（未达到对 16.4 个月，p=0.161），与 IM 升级组相比。两组均有反应和稳定疾病（SD）的患者，以及接受手术且 KIT 外显子 9 突变的 IM 升级患者，PFS 均良好。最常见的非血液学不良事件是 IM 升级组的水肿和舒尼替尼组的手足综合征和高血压。
IM 升级和舒尼替尼治疗的结果相当。医生在选择这些治疗方法时应考虑激酶突变和特定的不良反应。
