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• At initial progression, a switch from imatinib to sunitinib should be considered only if imatinib causes life-threatening side effects that cannot be managed by maximum supportive treatment¹
• Surgical resection of progressing lesion(s) should be considered, if feasible^1,4

ABOUT 1 IN 3 PATIENTS BENEFITED WITH DOSE ESCALATION¹

Many patients with progression achieved disease control with GLIVEC 800 mg/day¹

• 31% of patients in a Phase 3 unresectable and/or metastatic study who dose-escalated to 800 mg/day after progression at 400 mg/day achieved stable disease or partial response²
  • Median PFS after crossover to 800 mg/day was 5 months (95% CI, 2 to 10 months)²
  • Patients who tolerated the 400-mg dose prior to dose escalation were less likely to require dose reductions at the 800-mg level than patients initiated at the higher dose¹

RESPONSE EVALUATION IN GIST IS CRUCIAL AND REQUIRES CAREFUL INTERPRETATION^1,2,3

Adequate time must be allowed for response to GLIVEC

• Median time to response was 13 weeks (range 12 to 23 weeks)⁴
• Compliance and drug-drug interactions should be evaluated and discussed with patient⁵
• Treatment with GLIVEC may be continued as long as there is no evidence of progressive disease or unacceptable toxicity⁴

Changes in both tumor size and density should be considered in evaluating response to GLIVEC therapy in patients with KIT+ GIST³

• Choi response criteria evaluate tumor size* and density (measured in Hounsfield units [HU])¹
  • A partial response to treatment may be characterized by a decrease in tumor size of ≥10% OR a decrease in density (HU) of ≥15% on CT

Stable disease is a valid marker for benefit from therapy⁶

• Patients showing nonprogression of disease by 6 months of treatment had the same outcomes as those who showed complete or partial response⁶
• Absence of progression, as assessed by RECIST, was an excellent predictor of benefit in terms of PFS and OS⁶

OPTIMIZE TREATMENT WITH GLIVEC

GLIVEC has demonstrated efficacy in KIT+ GIST regardless of mutational status¹

• Approximately 95% of GISTs are KIT+; the vast majority have activating mutations in the KIT and PDGFRA genes²
• A mutational analysis is considered important in the diagnosis of KIT- GIST³
• KIT exon 11 and 9 mutations are responsive to GLIVEC therapy¹
  • 93% of assessable patients with KIT exon 11 mutations achieved disease control, with 72% showing objective response in a large Phase 3 study
  • 89% of assessable patients with KIT exon 9 mutations achieved disease control, with 44% showing objective response in the same study

In advanced KIT+ GIST, GLIVEC 800 mg/day is the consensus recommendation for patients with a KIT exon 9 mutation³

• In patients with KIT exon 9 mutations, 800 mg/day reduced the estimated risk of progression by 42% vs 400 mg/day⁴
• Objective response was significantly higher in patients with exon 9 mutations at 800 mg/day than at 400 mg/day (67% vs 17%; P=0.02)¹
  • Time to progression (TTP) doubled to 18 months at the higher dose but was not statistically significant¹
• Relative frequency for GISTs with KIT exon 9 mutations is 10%⁵
  • 95% of tumors with KIT exon 9 mutations are in the small bowel²