title: Rapid relapse after resection of a sunitinib-resistant gastrointestinal stromal tumor harboring a secondary mutation in exon 13 of the c-KIT gene.
abstract: We describe a case with rapid relapse after resection of a sunitinib-resistant gastrointestinal stromal tumor (GIST). Liver metastases and foci of left retroperitoneal recurrence developed during adjuvant imatinib treatment. The tumors did not shrink after sunitinib treatment, and hepatectomy and retroperitoneal tumorectomy were performed. Histological examination showed a Ki67 labeling index of over 50% in viable tumor cells. Genomic analysis revealed mutations in exons 11 and 13 of the c-KIT gene. Computed-tomographic scan revealed retroperitoneal recurrence at the surgical site five weeks post-operatively. In this case, high proliferative activity of the recurrent foci was associated with resistance to sunitinib and rapid recurrence during the perioperative withdrawal of sunitinib. It is important to consider the possibility of an exon 13 mutation with an aggressive phenotype when treating sunitinib-resistant GISTs. Surgical intervention for sunitinib-resistant GISTs should be carefully considered if R0 resection is not possible.
authors.affiliation: Second Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. kikuchih@hama-med.ac.jp
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Kikuchi
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Setoguchi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hiramatsu
authors.forename: Manabu
authors.initials: M
authors.lastname: Ohta
authors.forename: Kinji
authors.initials: K
authors.lastname: Kamiya
authors.forename: Takanori
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Konno
mesh_terms: D000970:Antineoplastic Agents / Q000494:pharmacology; D019008:Drug Resistance, Neoplasm; D005091:Exons; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy / Q000235:genetics* / Q000601:surgery*; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000235:genetics* / Q000601:surgery*; D006801:Humans; D007211:Indoles / Q000494:pharmacology; D008113:Liver Neoplasms / Q000556:secondary; D008297:Male; D008875:Middle Aged; D017354:Point Mutation; D019009:Proto-Oncogene Proteins c-kit / Q000235:genetics*; D011758:Pyrroles / Q000494:pharmacology; D012008:Recurrence; D000077210:Sunitinib
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D019009:Proto-Oncogene Proteins c-kit; D000077210:Sunitinib