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Patterns of Care, Prognosis, and Survival in Patients with Metastatic Gastrointestinal Stromal Tumors (GIST) Refractory to First-Line Imatinib and Second-Line Sunitinib

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Data regarding the management and outcome of patients with metastatic gastrointestinal stromal tumors (GIST) refractory to 1st-line imatinib and 2nd-line sunitinib are limited.

Methods

Medical records of 223 imatinib-resistant and sunitinib-resistant GIST who were treated in 11 major referral centers were reviewed.

Results

The three most frequent drugs used in the 3rd-line setting were: nilotinib n = 67 (29.5%), sorafenib n = 55 (24.5%), and imatinib n = 40 (17.5%). There were 18 patients (8%) who received best supportive care (BSC) only. The median progression-free survival (PFS) and overall survival (OS) on 3rd-line treatment were 3.6 months [95% confidence interval (95% CI), 3.1–4.1] and 9.2 months (95% CI, 7.5–10.9), respectively. Multivariate analysis showed that, in the 3rd-line setting, albumin level and KIT/PDGFRA mutational status were significantly associated with PFS, whereas performance status and albumin level were associated with OS. After adjustment for prognostic factors, nilotinib and sorafenib provided the best PFS and OS. Rechallenge with imatinib was also associated with improved OS in comparison with BSC.

Conclusion

In the 3rd-line setting, rechallenge with imatinib provided limited clinical benefit but was superior to BSC. Sorafenib and nilotinib have significant clinical activity in imatinib-resistant and sunitinib-resistant GIST and may represent an alternative for rechallenge with imatinib.

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Authors and Affiliations

  1. Institut Bergonié, Bordeaux, France

    Antoine Italiano MD, PhD, Maud Toulmonde MD, Jean-Michel Coindre MD, PhD & Binh Bui MD

  2. Memorial Sloan Kettering Cancer Center, New York, USA

    Antoine Italiano MD, PhD, Angela Cioffi MD, Robert G. Maki MD, PhD, Mary Louise Keohan MD & Cristina R. Antonescu MD

  3. Institut Gustave Roussy, Villejuif, France

    Angela Cioffi MD, Axel Le Cesne MD & Paolo Casali MD

  4. Istituto dei Tumori, Milan, Italy

    Paola Coco MD

  5. Department of Medicine/Pediatrics, Mount Sinai School of Medicine, New York, USA

    Robert G. Maki MD, PhD

  6. Department of General Medical Oncology and Laboratory of Experimental Oncology, University Hospitals Leuven, Leuven Cancer Institute, Catholic University Leuven, Leuven, Belgium

    Patrick Schöffski MD, PhD

  7. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland

    Piotr Rutkowski MD

  8. Hôpital La Timone, Marseille, France

    Florence Duffaud MD

  9. Centre Oscar Lambret, Lille, France

    Antoine Adenis MD

  10. Centre Georges François Leclerc, Dijon, France

    Nicolas Isambert MD

  11. Centre René Gauducheau, Nantes, France

    Emmanuelle Bompas MD

  12. Centre Léon Bérard, Lyon, France

    Jean-Yves Blay MD, PhD

  13. Department of Human Genetics, University Hospital Leuven, Leuven, Belgium

    Maria Debiec-Rychter MD, PhD

Authors
  1. Antoine Italiano MD, PhD
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  2. Angela Cioffi MD
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  3. Paola Coco MD
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  4. Robert G. Maki MD, PhD
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  7. Axel Le Cesne MD
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  11. Emmanuelle Bompas MD
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  12. Jean-Yves Blay MD, PhD
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  13. Paolo Casali MD
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  14. Mary Louise Keohan MD
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  15. Maud Toulmonde MD
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  16. Cristina R. Antonescu MD
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  17. Maria Debiec-Rychter MD, PhD
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  18. Jean-Michel Coindre MD, PhD
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  19. Binh Bui MD
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Correspondence to Antoine Italiano MD, PhD.

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Italiano, A., Cioffi, A., Coco, P. et al. Patterns of Care, Prognosis, and Survival in Patients with Metastatic Gastrointestinal Stromal Tumors (GIST) Refractory to First-Line Imatinib and Second-Line Sunitinib. Ann Surg Oncol 19, 1551–1559 (2012). https://doi.org/10.1245/s10434-011-2120-6

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  • DOI: https://doi.org/10.1245/s10434-011-2120-6

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