title: Imatinib mesylate induces responses in patients with liver metastases from gastrointestinal stromal tumor failing intra-arterial hepatic chemotherapy.
abstract: BACKGROUND
  Imatinib mesylate represents a real major paradigm shift in cancer therapy, targeting the specific molecular abnormalities, crucial in the etiology of tumor. Intra-arterial hepatic chemotherapy (IAHC) followed by embolization, has been considered an interesting palliative option for patients with liver metastases from gastrointestinal stromal tumor (GIST), due to the typically hypervascular pattern of the tumor.
  
  
  OBJECTIVE
  We report our experience with IAHC followed by Imatinib mesylate, in order to show the superiority of the specific molecular approach in liver metastases from GIST.
  
  
  METHODS
  Three patients (pts) with pretreated massive liver metastases from GIST, received IAHC with Epirubicin 50 mg/mq, every 3 weeks for 6 cycles. At the evidence of progression, they received Imatinib mesylate.
  
  
  RESULTS
  We observed progressive diseases in all cases. In 1998, one patient underwent Thalidomide at 150 mg orally, every day for 4 months, with evidence of stable disease and clinical improvement. In 2001, two patients received Imatinib mesylate at 400 mg orally, every day, with evidence of partial response lasting 18+ months and 16 months. One of them had grade 3 neutropenia, with suspension of therapy for 3 weeks.
  
  
  CONCLUSIONS
  No patient treated with IAHC, reported objective responses, but two of them obtained partial response after the assumption of Imatinib mesylate and one showed temporary stabilization with thalidomide. Imatinib mesylate represents a new opportunity in GIST therapy, targeting the specific molecular alteration. It seems to be superior to conventional intra arterial hepatic chemotherapy.
authors.affiliation: Department of Medical Oncology, San Giuseppe General Hospital, Empoli (Florence), Italy. oncologiaempoli@usl11.toscana.it
authors.forename: Giammaria
authors.initials: G
authors.lastname: Fiorentini
authors.forename: Paolo
authors.initials: P
authors.lastname: Bernardeschi
authors.forename: Sussana
authors.initials: S
authors.lastname: Rossi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Dentico
authors.forename: Mauro
authors.initials: M
authors.lastname: Biancalani
authors.forename: Gloria
authors.initials: G
authors.lastname: Giustarini
authors.forename: Gina
authors.initials: G
authors.lastname: Turrisi
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001549:Benzamides; D003131:Combined Modality Therapy; D019008:Drug Resistance, Neoplasm; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000473:pathology* / Q000601:surgery; D006499:Hepatic Artery; D006801:Humans; D000068877:Imatinib Mesylate; D007261:Infusions, Intra-Arterial; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000627:therapeutic use*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D013792:Thalidomide / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D015251:Epirubicin; D013792:Thalidomide; D000068877:Imatinib Mesylate