Nakatsuka Rie, Takahashi Tsuyoshi, Miyazaki Yasuhiro, Kurokawa Yukinori, Yamasaki Makoto, Miyata Hiroshi, Nakajima Kiyokazu, Takiguchi Shuji, Mori Masaki, Doki Yuichiro
Dept. of Gastroenterological Surgery, Graduate School of Mmedicine, Osaka University.
Gan To Kagaku Ryoho. 2014 Nov;41(12):2478-80.
A 62-year-old man presented to our hospital with multiple liver metastases of gastric gastrointestinal stromal tumor (GIST) in 2002.T he patient had undergone imatinib treatment for liver metastases as a participant in a clinical trial, and he had achieved complete response (CR) for 89 months.However, imatinib treatment was disrupted at the request of the patient. Progression of liver metastases was observed 18 months later.Imatinib treatment was reinitiated, and a partial response was obtained.Twenty -five months later, progression of disease was observed in segment 7 of the liver on an abdominal computed tomography (CT) scan. Partial imatinib-resistance was diagnosed, and partial resection of the lesion in S7 of the liver was performed in 2013. Imatinib therapy was continued after surgical intervention, and no progression has been detected for 10 months. Despite the beneficial effects of imatinib in patients with advanced GISTs, almost all patients have been reported to develop disease progression when imatinib is interrupted, even in lesions showing radiographic improvement.In the present case, after treatment with imatinib for 7 years, progression of liver metastases was observed upon discontinuation of therapy. Moreover, progression after disruption of imatinib may lead to the emergence of drug-resistant clones. We reported a case of recurrent GIST progressed after interruption of long-term imatinib therapy, which has been reported few times previously.
2002年,一名62岁男性因胃胃肠道间质瘤(GIST)多发肝转移入住我院。该患者作为临床试验参与者接受了伊马替尼治疗肝转移,获得了89个月的完全缓解(CR)。然而,应患者要求中断了伊马替尼治疗。18个月后观察到肝转移进展。重新开始伊马替尼治疗,获得了部分缓解。25个月后,腹部计算机断层扫描(CT)显示肝脏第7段出现疾病进展。诊断为部分伊马替尼耐药,2013年对肝脏S7段病变进行了部分切除。手术干预后继续伊马替尼治疗,10个月来未检测到进展。尽管伊马替尼对晚期GIST患者有有益作用,但几乎所有患者在伊马替尼中断治疗时均出现疾病进展,即使是影像学显示改善的病变。在本病例中,伊马替尼治疗7年后,停药后观察到肝转移进展。此外,伊马替尼中断治疗后的进展可能导致耐药克隆的出现。我们报告了一例长期伊马替尼治疗中断后复发进展的GIST病例,此前鲜有报道。