In patients with gastrointestinal stromal tumor (GIST) presenting at a locally advanced stage, direct upfront surgery may not achieve complete resection. A specific front-line treatment strategy is indicated to optimise the conditions for a successful surgical outcome.

Clinical Scenario

This protocol addresses patients with locally advanced GIST in whom tumour extent makes immediate complete resection challenging. A treatment strategy based on front-line medical therapy followed by surgery can be occasionally indicated in this population.

Treatment Approach (Partial Overview)

For eligible patients, a neoadjuvant approach with imatinib is considered to reduce tumour burden and facilitate complete (R0) surgical resection. Molecular profiling before treatment initiation is an integral part of the strategy, guiding subsequent management. The complete treatment sequence, surgical timing criteria, and perioperative planning are detailed in the full protocol.

Clinical Goals

The primary objective is tumour response. Early response assessment — recommended approximately 4 weeks after treatment initiation — is a critical checkpoint, as an unsuccessful treatment course could affect the feasibility of the planned surgical procedure.

References

DOI: 10.1177/17588359231192388

A treatment strategy based on front-line imatinib followed by surgery can be occasionally indicated in GIST patients with locally advanced disease.
Treatment with neoadjuvant imatinib can be considered in a multidisciplinary tumor board in GIST patients with locally advanced disease in which tumor shrinkage can facilitate the surgical procedure (III,A).
However, it is estimated that surgery could be performed between 6 and 12 months after initiation of imatinib, as maximal response and minimal risk of secondary resistance are expected in this time interval.
Imatinib can be stopped 24 h before the surgery and reinitiated once the oral tolerance has been confirmed.
Early response assessment, that is, after 4 weeks of treatment initiation is highly recommended since an unsuccessful imatinib treatment could impede a surgical procedure that otherwise could have been undertaken.

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Treatment of Locally Advanced Gastrointestinal Stromal Tumor

Clinical Scenario

Treatment Approach (Partial Overview)

Clinical Goals

References