U.S. ResidentsAfter GI/Surgeon Diagnosis
| 58 years old 1 week since diagnosis |
Ileal KIT+ GIST Original tumor: 6 cm Mitotic rate: ≤5/50 HPFs |
24% RISK OF RECURRENCE1 |
Patients whose GIST is identified by a gastroenterologist or surgeon need to know:
- GIST is a soft tissue sarcoma, a serious cancer2
- GIST has malignant potential, even after resection2,3
- All patients should be managed by a multidisciplinary team with expertise in sarcoma2
- For patients with KIT+ GIST, adjuvant therapy with GLIVEC can significantly lower the risk of tumor recurrence4
Give every KIT+ GIST patient the opportunity to discuss GLIVEC adjuvant therapy with a medical oncologist.
Risk of Recurrence
SURGERY ALONE DOES NOT PREVENT TUMOR RECURRENCE1
1 in 2 patients experience recurrence of GIST after surgery1
- Even after a complete resection, micrometastases that are not diagnostically visible pose the threat of tumor recurrence2,3
- The median time to recurrence is approximately 1.5 to 2 years4
In accordance with current ESMO and NCCN guidelines, mitotic rate, tumor site, and tumor size should be considered in risk assessments1,5
Rates of metastases or tumor-related death in GIST6,a
| MITOTIC RATE (HPFs) |
TUMOR SIZE (cm) |
GASTRIC GIST |
JEJUNAL AND ILEAL GIST |
DUODENAL GIST | RECTAL GIST |
|---|---|---|---|---|---|
| ≤5/50 | ≤2 | 0% | 0% | 0% | 0% |
| >2 ≤5 | 1.9% | 4.3% | 8.3% | 8.5% | |
| >5 ≤10 | 3.6% | 24% | 34%b | 57%b | |
| >10 | 12% | 52% | |||
| >5/50 | ≤2 | 0%b | 50%b | N/Ac | 54% |
| >2 ≤5 | 16% | 73% | 50% | 52% | |
| >5 ≤10 | 55% | 85% | 86%b | 71%b | |
| >10 | 86% | 90% |
a | Based on previously published long-term follow-up studies on 1055 gastric, 629 small intestinal, 144 duodenal, and 111 rectal GISTs. |
b | Denotes tumor categories with very small numbers of cases. Some data combined, or missing, due to a small number of cases. |
c | No tumors of such category were included in the study. Note that small intestinal and other intestinal GISTs show a markedly worse prognosis in many mitosis and size categories than gastric GISTs. HPFs=high power fields. Adapted from Miettinen and Lasota, 2006.6 |
- Risk tolerance is subjective and every patient should have the opportunity to articulate his or her level of comfort with risk
- When assessing next steps after surgery, patients depend on their healthcare team to help them navigate to the most appropriate specialist
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Guidelines
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References
- The NCCN Soft Tissue Sarcoma Clinical Practice Guidelines in Oncology (Version 2.2010). ©2010 National Comprehensive Cancer Network, Inc. http://www.nccn.org. Accessed August 28, 2010. To view the most recent and complete version of the guidelines, go online to www.nccn.org.
- Dictionary of cancer terms. National Cancer Institute Web site. http://www.cancer.gov/dictionary. Accessed April 29, 2010.
- Demetri GD. Gastrointestinal stromal tumors. In: DeVita VT Jr, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenbergs Cancer: Principles & Practice of Oncology. Vol 1. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008:1204-1217.
- DeMatteo RP. The GIST of targeted cancer therapy: a tumor (gastrointestinal stromal tumor), a mutated gene (c-kit), and a molecular inhibitor (STI571). Ann Surg Oncol. 2002;9(9):831-839.
- Casali PG, Blay J-Y; for the ESMO/CONTICANET/EUROBONET Consensus Panel of Experts. Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(suppl 5):v98-v102.
- Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006;23(2):70-83.
Referring to an Oncologist
CO-MANAGE WITH OR REFER TO A MEDICAL ONCOLOGIST AFTER GIST RESECTION
A multidisciplinary approach helps optimize patient outcomes in GIST1,2,3
- Consultation with a medical oncologist gives the patient with KIT+ GIST the opportunity to extend recurrence-free survival with GLIVEC as adjuvant therapy
- A multidisciplinary team specializing in sarcoma may work together to reduce recurrent disease, optimize the timing of surgery, and prolong survival for patients with KIT+ GIST2,3
- Involving a medical oncologist gives the patient access to a specialist in cancer care and adjuvant treatment options3
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References
- Casali PG, Blay J-Y; for the ESMO/CONTICANET/EUROBONET Consensus Panel of Experts. Gastrointestinal stromal tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21(suppl 5):v98-v102.
- Demetri GD, von Mehren M, Antonescu CR, et al. NCCN Task Force report: update on the management of patients with gastrointestinal stromal tumors. J Natl Compr Canc Netw. 2010;8(suppl 2):S1-S41.
- Reichardt P, Blay J-Y, von Mehren M. Towards global consensus in the treatment of gastrointestinal stromal tumor. Expert Rev Anticancer Ther. 2010;10(2):221-232.
- DeMatteo RP, Ballman KV, Antonescu CR, et al; for the American College of Surgeons Oncology Group (ACOSOG) Intergroup Adjuvant GIST Study Team. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet. 2009;373(9669):1097-1104.
Learn more about a
multidisciplinary
approach to treating
KIT+ GIST
References
- Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol. 2006;23(2):70-83.
- The NCCN Soft Tissue Sarcoma Clinical Practice Guidelines in Oncology (Version 2.2010). ©2010 National Comprehensive Cancer Network, Inc. http://www.nccn.org. Accessed August 28, 2010. To view the most recent and complete version of the guidelines, go online to www.nccn.org.
- Fletcher CDM, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors: a consensus approach. Hum Pathol. 2002;33(5):459-465.
- DeMatteo RP, Ballman KV, Antonescu CR, et al; for the American College of Surgeons Oncology Group (ACOSOG) Intergroup Adjuvant GIST Study Team. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet. 2009;373(9669):1097-1104.
