Neoadjuvant therapy with tyrosine kinase inhibitors can facilitate the resection of gastrointestinal stromal tumors (GIST) in some higher-risk patients, according to a new study published in the American Journal of Surgery. However it does not result in an independent oncologic benefit,” the authors said.

The aim of neoadjuvant therapy with tyrosine kinase inhibitors in GIST is to facilitate less morbid resections as well as improve oncologic outcomes. But its use and effects are not well studied.

Here, a team of researchers led by Skye C. Mayo, MD, MPH, FACS, at Knight Cancer Institute in Portland, Oregon reviewed the cases of 254 patients with resected nonmetastatic GISTs. The researchers assessed patients’ overall and recurrence-free survival.


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The results showed that there were no differences in 10-year overall survival, 5-year recurrence-free survival, or median recurrence-free survival between patients treated with neoadjuvant therapy compared to those not treated with neoadjuvant therapy before resection. There were also no differences between those treated or not treated with neoadjuvant therapy in terms of length of hospital stay and Clavien-Dindo complications grade 3 or higher.

The researchers concluded that even though there does not seem to be an independent oncologic benefit in using neoadjuvant therapy with tyrosine kinase inhibitors compared to upfront resection, the therapy does also not result in worse oncologic outcomes and may even facilitate resection in some patients.

“Therapy delivered in the [neoadjivant therapy] setting may be efficacious in stabilizing or reducing the size of GISTs prior to curative-intent resection,” they wrote, “but definitive evidence of successful down-staging is difficult to determine.”

More research is needed to compare the effect of neoadjuvant therapy to upfront resection in patients who are also treated with equal lengths of adjuvant tyrosine kinase inhibitor therapy, the authors concluded.

Reference

Wong LH, Sutton TL, Sheppard BC, Corless CL, Heinrich MC, Mayo SC. Neoadjuvant tyrosine kinase inhibitor therapy for patients with gastrointestinal stromal tumor: a propensity-matched analysis. Am J Surg. Published online March 31, 2022. doi:10.1016/j.amjsurg.2022.03.045