Longer treatment with adjuvant imatinib with shorter postoperative delay leads to longer recurrence-free survival in patients with gastrointestinal stromal tumor (GIST), according to a retrospective cohort study published in the Journal of Cancer Research and Clinical Oncology. 

If confirmed with further studies, this result could help guide decision-making about the best treatment regimen following GIST surgery.

Imatinib treatment has been shown to prolong overall survival across all GIST presentations since its first use in 2000 and adjuvant imatinib has been recommended as the standard first-line treatment of GIST patients with a high risk of recurrence. However, the cost of imatinib treatment can be burdensome and its availability is limited, especially in underdeveloped and developing countries.

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To investigate the impact of delayed treatment with adjuvant imatinib after surgery in patients with GIST and a high risk of recurrence, a team of researchers led by Wu Xiaoting, MD, FACS retrospectively collected data about GIST patients from the West China Hospital between 2011 and 2018. They then analyzed 222 patients with a high risk of recurrence who had radical surgery and received adjuvant imatinib treatment.

imatinib GIST
A model of a molecule of Imatinib, also known as Gleevec and Glivec. It is used in cancer treatment, especially for forms of leukemia and gastrointestinal cancer. Unlike more conventional chemotherapy treatments, it does not act by attacking all cells undergoing rapid division (which include cancer cells, but also hair folicles and bone marrow). Instead it works by inhibiting certain enzymes involved in the division of cancer cells.Isolated on white.
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The researchers found that patients who started adjuvant imatinib treatment 2 months or less after surgery had significantly more favorable recurrence-free survival compared to those who received treatment 4 to 6 months after surgery. However, there was no difference in recurrence-free survival between patients who received treatment after 2 months or less and those who started treatment between 2 months and 4 months after surgery. 

The researchers also found that patients taking adjuvant imatinib for over a year had longer recurrence-free survival compared to those who were treated for 1 year or less. 

For patients treated for 1 year or less, there was no difference in recurrence-free survival regardless of when the treatment was started after surgery. However, patients who were treated with adjuvant imatinib for more than a year, and those who started treatment earlier (2 months or less after surgery and even 2 to 4 months after surgery) had significantly more favorable recurrence-free survival compared to those who started treatment between 4 months and 6 months after surgery. 

“Delayed postoperative adjuvant imatinib for over 4 months in patients with high risk of recurrence of GIST may lead to worse [recurrence-free survival],” the authors concluded. 

Reference

Qianyi W, Mei X, Rui Z, et al. Delayed adjuvant imatinib in patients with high risk of recurrence of gastrointestinal stromal tumor after radical surgery: a retrospective cohort study. J Cancer Res Clin Oncol. Published online July 28, 2021. doi:10.1007/s00432-021-03749-6

Gastroenterologists Imatinib