ONCAlert | 2018 SGO Annual Meeting on Women’s Cancer
Trent Recurrent Gist Case Studies

Case Studies: Recurrent Metastatic Gastrointestinal Stromal Tumor

In this case-based interview, Jon Trent, MD, PhD, provides an overview on the diagnosis and treatment of a patient who develops disease progression after resection of metastatic gastrointestinal stromal tumor.
 

Recurrent Metastatic Gastrointestinal Stromal Tumor

September 2014

  • A 64-year old Caucasian male presented with abdominal pain and 3-month history of fatigue
    • PMH was remarkable for hypertension well-controlled with a beta-blocker
    • No family history of cancer
    • He could perform all activities independently
  • Abdominal CT findings:
    • 12-cm mass arising from the stomach and involving the cardia, fundus, and body of the stomach
    • 7-cm solitary mass in the left lobe of the liver
  •  Biopsy results:
    • Gastric GIST with liver metastases
    • IHC positive for CD117 (c-KIT), molecular analysis showed exon 9 deletion
    • Mitotic activity, high with >5 mitoses/50 HPFs
  • Treatment was initiated with neoadjuvant imatinib 600 mg daily for 5 months
    • The primary tumor was stable during this time, the liver mass size decreased from 7 cm to 4 cm
  • The patient was referred to a surgeon and underwent hepatectomy for the liver metastasis
    • Following surgery, R0 resection with clear margins
  • Treatment was initiated with imatinib 800 mg daily

August 2016

  • Abdominal CT imaging findings:
    • Multiple peritoneal implants
    • A new small nodule (<1 cm) in the liver
  • The patient could perform all activities independently with small occasional breaks, but could not perform physically strenuous activities
  • He was switched to sunitinib 37.5 mg daily

February 2017

  • At his 6-month follow-up, the patient was still able to perform most non-strenuous activities independently; however, the frequency of being able to do so had declined significantly
  • Abdominal CT scan showed progression in multiple peritoneal implants; the liver nodule increased in size to 2 cm
  • He was referred to an academic center
    • His treatment was switched to regorafenib 160 mg, 3 weeks on, 1 week off
  • The patient appeared to tolerate therapy well, after initial dose modification due to diarrhea experienced during the second week of therapy
  •  At the 6-month follow-up:
    • Abdominal CT scan showed slight reduction in the peritoneal implants
    • The liver nodule was no longer visible
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