Shirakawa Tsuyoshi, Hirata Tomoya, Maemura Kosuke, Goto Toshiyuki, Shimao Yoshiya, Marutsuka Kosuke, Ueda Yuji, Kikuchi Ikuo
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki 880-8510, Japan.
Department of Oncology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki 880-8510, Japan.
Mol Clin Oncol. 2017 Jul;7(1):93-97. doi: 10.3892/mco.2017.1268. Epub 2017 May 23.
Gastrointestinal stromal tumors (GISTs) are a type of sarcoma, and the most common mesenchymal tumor of the gastrointestinal tract. Systemic chemotherapy is recommended for unresectable or metastatic GISTs. Imatinib is an oral multitargeted receptor tyrosine kinase inhibitor that is effective as adjuvant chemotherapy for primary high-risk cases, and as palliative chemotherapy for unresectable or metastatic cases. For imatinib-resistant cases, second-line chemotherapy with sunitinib is recommended due to significantly longer median progression-free survival and higher response rates compared with a placebo. A 54-year-old woman presented with persistent upper abdominal pain and anorexia. An upper gastrointestinal endoscopy and computed tomography revealed a submucosal tumor of the stomach with no apparent metastases. The patient underwent total radical gastrectomy, and was diagnosed histologically with high-risk GIST for recurrence, therefore, the patient received adjuvant chemotherapy with imatinib. However, multiple liver and lymph node metastases were detected, and the patient received sunitinib therapy. After four cycles of sunitinib, the liver and lymph node metastases disappeared, and a complete response (CR) was achieved. To date, there have been no cases of CR in the prospective clinical trials examining the effects of sunitinib, or in case reports worldwide. Therefore, this is a very rare case report of a patient with metastatic GISTs who achieved CR with sunitinib as second-line chemotherapy.
胃肠道间质瘤（GISTs）是一种肉瘤，也是胃肠道最常见的间叶组织肿瘤。对于不可切除或转移性GISTs，推荐进行全身化疗。伊马替尼是一种口服多靶点受体酪氨酸激酶抑制剂，对原发性高危病例作为辅助化疗有效，对不可切除或转移性病例作为姑息化疗有效。对于伊马替尼耐药的病例，推荐使用舒尼替尼进行二线化疗，因为与安慰剂相比，其无进展生存期的中位数显著延长，缓解率更高。一名54岁女性出现持续性上腹痛和厌食。上消化道内镜检查和计算机断层扫描显示胃黏膜下肿瘤，无明显转移。患者接受了根治性全胃切除术，组织学诊断为复发高危GIST，因此，患者接受了伊马替尼辅助化疗。然而，检测到多处肝转移和淋巴结转移，患者接受了舒尼替尼治疗。经过四个周期的舒尼替尼治疗，肝转移和淋巴结转移消失，达到完全缓解（CR）。迄今为止，在研究舒尼替尼疗效的前瞻性临床试验或全球病例报告中，均未出现CR病例。因此，这是一例非常罕见的转移性GISTs患者接受舒尼替尼二线化疗后达到CR的病例报告。
