Katsumata Ryo, Monobe Yasumasa, Katata Yosuke, Fujiwara Hideyo, Urano Takashi, Akagi Akihisa, Tsujimoto Kotone, Konishi Takako, Manabe Noriaki, Kamada Tomoari, Kawamoto Hirofumi, Yamatsuji Tomoki, Naomoto Yoshio
Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan.
Department of Pathology, Kawasaki Medical School General Medical Center, Okayama, Japan.
Case Rep Gastroenterol. 2023 Feb 17;17(1):109-116. doi: 10.1159/000529002. eCollection 2023 Jan-Dec.
Tyrosine kinase inhibitors (TKIs) such as imatinib improve the prognosis of patients with gastrointestinal stromal tumors (GISTs). However, treatment options for GISTs are still limited, and the continuation of TKIs is difficult due to adverse events in some cases. The effectiveness of low-dose imatinib is unclear. We report 2 cases to show effectiveness of low-dose imatinib in patients with adverse events. The first case is a male in his early 60s with a history of intestinal GIST resection who was diagnosed with recurrent GIST with peritoneal dissemination. He was started on low-dose imatinib (300 mg) because of a history of subconjunctival hemorrhage after receiving postoperative imatinib. Follow-up contrast-enhanced ultrasonography revealed that the tumors had shrunk in size and number after 2 months of treatment with 300-mg imatinib. He continued this treatment and showed partial response for 8 months. The second case is a female in her late 70s with rectal GIST who was treated with imatinib 400 mg. Due to a severe skin lesion, she changed her treatment to sunitinib 2 months after initiation. However, new metastasis in the liver was confirmed after 4 months of administration of sunitinib. She underwent surgical esection of the rectal tumor to reduce the volume. After the surgery, low-dose imatinib (300 mg) with oral steroids was adopted. Follow-up confirmed the absence of recurrence at the rectum and no increase in hepatic tumor size for 18 months. Aggressive treatment with low-dose imatinib instead of discontinuation or alteration of treatment may benefit patients with unresectable and postoperative GISTs with sensible mutation to imatinib.
酪氨酸激酶抑制剂（TKIs），如伊马替尼，可改善胃肠道间质瘤（GISTs）患者的预后。然而，GISTs的治疗选择仍然有限，在某些情况下，由于不良事件，伊马替尼的持续使用较为困难。低剂量伊马替尼的有效性尚不清楚。我们报告2例病例以显示低剂量伊马替尼对发生不良事件患者的有效性。第一例是一名60岁出头的男性，有肠道GIST切除病史，被诊断为复发性GIST伴腹膜播散。由于术后接受伊马替尼治疗后出现结膜下出血病史，他开始使用低剂量伊马替尼（300mg）。随访增强超声检查显示，使用300mg伊马替尼治疗2个月后，肿瘤的大小和数量均有所缩小。他继续这种治疗，并显示部分缓解达8个月。第二例是一名70多岁的女性，患有直肠GIST，接受400mg伊马替尼治疗。由于严重的皮肤病变，开始治疗2个月后她将治疗改为舒尼替尼。然而，使用舒尼替尼4个月后证实肝脏出现新转移。她接受了直肠肿瘤的手术切除以缩小肿瘤体积。手术后，采用低剂量伊马替尼（300mg）联合口服类固醇治疗。随访证实直肠无复发，肝脏肿瘤大小在18个月内未增加。对于不可切除和术后GISTs且对伊马替尼敏感突变的患者，采用低剂量伊马替尼积极治疗而非中断或改变治疗可能有益。
