Multidisciplinary care of gastrointestinal stromal tumour: a review and a proposal for a pre-treatment classification.
The introduction of receptor tyrosine kinase inhibitors (TKIs) has revolutionized the management of gastrointestinal stromal tumour (GIST). Strong evidence supports the use of imatinib as first-line treatment in metastatic or unresectable tumours and its efficacy in the post-operative adjuvant setting has been confirmed by phase III trials. There are a number of reports concerning the administration of imatinib in the pre-operative setting, however, the heterogeneity of the terminology used and the indications for pre-operative treatment make it difficult to determine the true value of pre-operative imatinib. Larger studies, or a phase III trial could be helpful but patient accrual and standardization of care could be difficult. We propose a pre-treatment classification of GIST in order to facilitate the comparison and collection of data from different institutions, and overcome the difficulties related to accrual. Moreover, in the current era of multidisciplinary treatment of GIST, an appropriate classification is mandatory to properly design clinical trials and plan stage-adapted treatment.
Department of Surgery, The Royal Marsden, Fulham Road, London SW3 6JJ, UK. Electronic address: fcm.cananzi@hotmail.it.
F C M
FC
Cananzi
I
I
Judson
B
B
Lorenzi
C
C
Benson
S
S
Mudan
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001549:Benzamides / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D002986:Clinical Trials as Topic; D005770:Gastrointestinal Neoplasms / Q000145:classification* / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D046152:Gastrointestinal Stromal Tumors / Q000145:classification* / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D006801:Humans; D000068877:Imatinib Mesylate; D033183:Interdisciplinary Communication; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy / Q000379:methods; D010348:Patient Care Team; D018579:Patient Selection; D010879:Piperazines / Q000627:therapeutic use*; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D012107:Research Design; D009626:Terminology as Topic
D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D000068877:Imatinib Mesylate
Classification; GIST; Imatinib; Pre-operative therapy; Surgery