Purpose of review
The treatment of gastrointestinal stromal tumors (GISTs) with tyrosine kinase inhibitors (TKIs), such as imatinib and sunitinib, has produced improved outcomes and survival. However, patients with high-risk tumors still have unacceptably high rates of recurrence and disease progression. In the current review, we examine the various strategies for optimizing the treatment of GISTs.
Extended duration of treatment (36 months) with adjuvant imatinib resulted in improved recurrence-free survival and overall survival, whereas discontinuation of the TKI led to relapse of disease in most high-risk patients. High-dose therapy of imatinib was beneficial for patients with KIT exon 9 mutations. Patients with KIT exon 11 mutations experienced the most improvement in outcomes from adjuvant imatinib.
The extended duration of TKI treatment, dose optimization, mutation status, and the effects of TKI discontinuation have recently been examined in more detail. As our understanding of TKI therapy grows, an individualized approach to each patient should lead to better outcomes.