Jonathan Trent, MD, PhD: A 64-year-old Caucasian male presents to the emergency room with fatigue and abdominal pain. He has no significant past medical history other than well-controlled hypertension that is managed with a beta blocker; he has no significant family history. An abdominal CT scan is performed and this reveals a 12-cm gastric mass involving the cardia and fundus, as well as a 7-cm solitary liver tumor.
A biopsy was performed revealing a gastrointestinal stromal tumor, or GIST, that was KIT-positive by immunohistochemistry, and found to have anexon 9mutation. The tumor was also found to be high-grade, with a greater than 5 per 50 high-power field mitotic rate. The patient was initiated on therapy with imatinib at the 600 mg per day dose; this was well toleratedthe patient maintained therapy for 5 months. At that time, the patient had another CT scan performed of the abdomen that revealed decrease in size of the solitary liver metastasis from 7 cm to 4 cm, with relative stability of the gastric mass. The patient was referred to a surgical oncologist who performed an R0 resection with negative margins of both the liver metastasis and the primary tumor in the stomach. Postoperatively, the patient recovered and was placed on imatinib 800 mg per day.
Patients with gastrointestinal stromal tumors present with a variety of different symptoms, largely depending on the location of the primary tumor. This patient had a primary tumor in the stomach. The patient presented with fatigue, probably related to anemia, as well as abdominal painthis presentation is consistent with a gastrointestinal stromal tumor in this anatomic location.
This patient with GIST was initially treated with 600 mg per day of imatinib, underwent surgical resection and postoperatively was placed on 800 mg per day of imatinib. This management is supported by the GIST metaanalysis that found that patients who have anexon 9mutation benefit from higher doses than 400 mg per day of imatinib, in terms of not only progression-free survival, but overall survival as well.
Transcript edited for clarity.
September 2014
August 2016
February 2017
PD-L1 Provides Valid Biomarker for Nivolumab/Chemo in Gastric Cancer
February 28th 2024In a discussion with Targeted Oncology, Michael Gibson, MD, PhD, discusses the benefits of using a patient’s PD-L1 combined positive score to determine if they are given nivolumab and chemotherapy to treat their gastric cancer.
Read More
The Impact of the Gut Microbiome in Young Patients With Colorectal Cancer
February 15th 2021In season 2, episode 2 of Targeted Talks, Cathy Eng, MD, speaks with Benjamin Weinberg, MD, about the gut microbiome, and how the presence of certain microbiota impact the onset and intensity of disease as well as the potential response to certain treatments.
Listen
FDA Approves IND Application of IMC001 for EpCAM+ Gastrointestinal Tumors
February 26th 2024The FDA has granted an investigational new drug application to the investigational chimeric antigen receptor T-cell therapy IMC001 for the treatment of EpCAM-positive advanced gastrointestinal tumors.
Read More