title: Adjuvant therapy in primary GIST: state-of-the-art.
abstract: BACKGROUND
  The management of primary gastrointestinal stromal tumours (GISTs) has evolved with the introduction of adjuvant therapy. Recently reported results of the SSG XVIII/AIO trial by the Scandinavian Sarcoma Group (SSG) and the German Working Group on Medical Oncology (AIO) represent a significant change in the evidence for adjuvant therapy duration. The objectives of this European Expert Panel meeting were to describe the optimal management and best practice for the systemic adjuvant treatment of patients with primary GISTs.
  
  
  METHODS
  A panel of medical oncology experts from European sarcoma research groups were invited to a 1-day workshop. Several questions and discussion points were selected by the organising committee prior to the conference. The experts reviewed the current literature of all clinical trials available on adjuvant therapy for primary GISTs, considered the quality evidence and formulated recommendations for each discussion point.
  
  
  RESULTS
  Clinical issues were identified and provisional clinical opinions were formulated for adjuvant treatment patient selection, imatinib dose, duration and patient recall, mutational analysis and follow-up of primary GIST patients. Adjuvant imatinib 400 mg/day for 3 years duration is a standard treatment in all patients with significant risk of recurrence following resection of primary GISTs. Patient selection for adjuvant therapy should be based on any of the three commonly used patient risk stratification schemes. R1 surgery (versus R0) alone is not an indication for adjuvant imatinib in low-risk GIST. Recall and imatinib restart could be proposed in patients who discontinued 1-year adjuvant imatinib within the previous 3 months and may be considered on a case-by-case basis in patients who discontinued within the previous year. Mutational analysis is recommended in all cases of GISTs using centralised laboratories with good quality control. Treatment is not recommended in an imatinib-insensitive D842V-mutated GIST. During adjuvant treatment, patients are recommended to be clinically assessed at 1- to 3-month intervals. Upon discontinuation, computed tomography scan (CT) scans are recommended every 3 to 4 months for 2 years when the risk of relapse is highest, followed by every 6 months until year 5 and annually until year 10 after treatment discontinuation.
  
  
  CONCLUSIONS
  Key points in systemic adjuvant treatment and clinical management of primary GISTs as well as open questions were identified during this European Expert Panel meeting on GIST management.
authors: Interdisciplinary Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany. Electronic address: peter.reichardt@helios-kliniken.de.
authors: P
authors: P
authors: Reichardt
authors: Department of Medicine, Centre Léon-Bérard, Lyon, France.
authors: J-Y
authors: JY
authors: Blay
authors: 2nd Department of Medical Oncology, Theagenion Cancer Hospital, Thessaloniki, Greece.
authors: I
authors: I
authors: Boukovinas
authors: Department of Internal Medicine 1/Division of Oncology, Medical University Vienna--General Hospital, Vienna, Austria.
authors: T
authors: T
authors: Brodowicz
authors: COTMES (Comité de Tumores Músculo-Esqueléticos), Mallorca, Spain.
authors: J M
authors: JM
authors: Broto
authors: Department of Cancer Medicine, Istituto Nazionale dei Tumori, Milan, Italy.
authors: P G
authors: PG
authors: Casali
authors: Department of Medical Oncology, Bank of Cyprus Oncology Centre, Nicosia, Cyprus.
authors: M
authors: M
authors: Decatris
authors: Skane University Hospital and Lund University, Lund, Sweden.
authors: M
authors: M
authors: Eriksson
authors: Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands.
authors: H
authors: H
authors: Gelderblom
authors: Medical Oncology Department, Hygeia Hospital, Athens, Greece.
authors: P
authors: P
authors: Kosmidis
authors: Department of Medicine, Institut Gustave Roussy, Villejuif Cedex, France.
authors: A
authors: A
authors: Le Cesne
authors: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors: A L
authors: AL
authors: Pousa
authors: Medical Clinic III, Ludwig Maximilians University, Munich, Germany.
authors: M
authors: M
authors: Schlemmer
authors: Department of Medical Oncology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: J
authors: J
authors: Verweij
authors: Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland.
authors: H
authors: H
authors: Joensuu
mesh_terms: D001549:Benzamides; D017024:Chemotherapy, Adjuvant; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy*; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy*; D006801:Humans; D000068877:Imatinib Mesylate; D010879:Piperazines / Q000627:therapeutic use*; D047428:Protein Kinase Inhibitors / Q000494:pharmacology; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors; D011743:Pyrimidines / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D000068877:Imatinib Mesylate; D011505:Protein-Tyrosine Kinases