Zhang Nan, Wu Xin, Xu Wentong, Chen Lin, Tu Xiaohuang
Department of Gastrointestinal Surgery, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
Senior Department of General Surgery, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
Ann Palliat Med. 2023 Jan;12(1):227-235. doi: 10.21037/apm-22-1361.
The surgical treatment of small intestinal stromal tumors is mainly based on the common experience of gastrointestinal stromal tumors (GISTs). The biological characteristics of tumors and secondary gene mutations during disease progression cause many difficulties in clinical treatment. Advanced GISTs usually have no chance to surgery especially after multiple lines of drug therapy and multiple surgeries. This case report provides a good example of rensformational surgery for advanced GIST.
In this report, we describe the case of a patient that is male 57 years old with a small intestinal stromal tumor (stage IV) treated in our center (The First Medical Centre, Chinese PLA General Hospital, Beijing, China) who underwent more than 20 years of first- to fourth-line tyrosine kinase inhibitor (TKI) drug treatment and three rounds of surgical treatment. In June 2020, the patient developed extensive metastases in the abdominal cavity, pelvic cavity, and liver, and could not be treated surgically. The patient was enrolled in the "two-arm clinical trial of bridge therapy with ripretinib and sunitinib in China", started four cycles of ripretinib drug therapy and tumor evaluation, and eventually achieved tumor remission. The patient received surgical treatment following conversion therapy and postoperative tumor recurrence. After continued targeted therapy with TKIs, disease progression was controlled, and the patient's survival was prolonged.
Type II TKIs such as ripretinib and avapritinib have enhanced the typically expected therapeutic effects of many advanced GISTs. For the late-line treatment of advanced GIST, new TKI drugs can be tried for conversion therapy while monitoring the whole process, grasp the timing of surgery to provide more effective treatment.
小肠间质瘤的外科治疗主要基于胃肠道间质瘤（GIST）的常见经验。肿瘤的生物学特性以及疾病进展过程中的继发基因突变给临床治疗带来诸多困难。晚期GIST通常没有手术机会，尤其是在经过多线药物治疗和多次手术后。本病例报告为晚期GIST的转化性手术提供了一个很好的例子。
在本报告中，我们描述了一名57岁男性小肠间质瘤（IV期）患者的病例，该患者在我们中心（中国人民解放军总医院第一医学中心，北京，中国）接受了20多年的一线至四线酪氨酸激酶抑制剂（TKI）药物治疗和三轮手术治疗。2020年6月，患者出现腹腔、盆腔和肝脏广泛转移，无法进行手术治疗。该患者参加了“中国瑞派替尼与舒尼替尼桥接治疗双臂临床试验”，开始了四个周期的瑞派替尼药物治疗和肿瘤评估，最终实现了肿瘤缓解。患者在转化治疗后接受了手术治疗，术后肿瘤复发。在继续使用TKIs进行靶向治疗后，疾病进展得到控制，患者生存期延长。
瑞派替尼和阿伐替尼等II型TKIs增强了许多晚期GIST的预期治疗效果。对于晚期GIST的后线治疗，可以尝试使用新的TKI药物进行转化治疗，同时全程监测，把握手术时机，以提供更有效的治疗。
