Reintroduction of imatinib in GIST.
OBJECTIVE
This review examines the clinical evidence showing that imatinib can be prescribed to treat recurrence or progression of gastrointestinal stromal tumors (GIST) in patients who interrupted first-line imatinib therapy in the adjuvant or advanced/metastatic setting.


METHODS
A literature search was performed in PubMed, Web of Knowledge, and Google using the following keywords: rechallenge/reinitiation/reintroduction + gastrointestinal + imatinib and rechallenge/reinitiation/reintroduction + imatinib.


RESULTS
The evidence indicates that the reintroduction of imatinib can benefit patients who experience GIST progression after interrupting treatment of advanced/metastatic disease, as well as patients who experience GIST recurrence after completing prescribed neoadjuvant and/or adjuvant therapy. Although reintroduction of imatinib may lead to suboptimal outcomes, as evidenced by higher rates of progressive disease compared to initial treatment, imatinib discontinuation does not appear to favor development of imatinib resistance, leaving dose escalation and third- or fourth-line imatinib treatment as viable options for patients.


CONCLUSIONS
Results indicate that after initial start and interruption of imatinib therapy, reintroduction of imatinib therapy is efficacious and provides continued survival benefit in patients with GIST.
Department of Hematology/Oncology, Moores UCSD Cancer Center, University of California, 3855 Health Sciences Drive, La Jolla, San Diego, CA, 92093, USA, tonyreid@ucsd.edu.
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D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides / Q000627:therapeutic use*; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy*; D006801:Humans; D000068877:Imatinib Mesylate; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010879:Piperazines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D016879:Salvage Therapy
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D000068877:Imatinib Mesylate