The Evolution of Treatment for GIST


Edwin Choy, MD, discusses the evolution of treatment for gastrointestinal stromal tumors, including surgery and targeted therapy.

Edwin Choy, MD, director of the Sarcoma Program at the Division of Hematology Oncology at Massachusetts General Hospital, a founding member of Mass General Brigham, associate professor of medicine at Harvard Medical School, discusses the evolution of treatment for gastrointestinal stromal tumors (GIST).

From 1970s to 1990s, treatment for GIST was a surgical endeavor. For these patients, regardless of the success of treatment, survival was impacted by the characteristics of their disease, according to Choy. Patients with metastatic disease fared worse than those with localized disease. The introduction of imatinib (Gleevec) for the adjuvant treatment of adult patients following complete gross resection of KIT mutation-positive GIST improved survival rates for patients regardless of disease stage, and this therapy started the targeted therapy revolution for the disease, explains Choy.


0:08 | Twenty years ago, there was a drug called imatinib that became very effective for GIST. Before that, there were no real effective drugs to treat GIST, so GIST was largely a surgical disease. We have a long record of how patients did without imatinib. In the 1970s, 1980s, 1990s, patients would be diagnosed with GIST and largely, if they have metastatic disease, they will eventually die from their disease in short order. If they had localized disease, their tumor would be surgically managed.

0:53 | Depending on the size, grade and location of the GIST, they would have different risk levels, and levels of risk to develop metastasis. Once we developed imatinib as a treatment for metastatic disease, that changed the landscape of how we considered GIST. Where the disease had maybe a 6–12-month prognosis, using imatinib prolonged survival to 4-7 years. That changed how people did. In terms of how we want to initially manage GIST surgically, I don't think any of that has changed because as wonderful a drug as imatinib is, it doesn't change the sort of inherent risk of metastasis that a tumor would have when it's first diagnosed.

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