title: Controversies in the management of gastrointestinal stromal tumors.
abstract: Major advances in the medical treatment of gastrointestinal tumors (GISTs) have improved survival for both patients with advanced disease and those diagnosed with high-risk primary tumors. The Consensus approaches to best practice management of gastrointestinal stromal tumors, published in this journal in 2008, provided guidance for the management of GIST to both clinicians and regulatory authorities. Since then, clinical trials have demonstrated the benefit of adjuvant imatinib in high-risk patients, and mature data from advanced GIST studies suggest that a small but significant proportion of patients with advanced disease can achieve long-term benefit with ongoing imatinib treatment. Other evolving management strategies include the controversial use of palliative or debulking surgery to improve outcomes in advanced GIST and the development of promising new multikinase inhibitors, such as regorafenib, which has established benefit in the third-line setting. This review provides an update of recent developments in GIST management and discusses new controversies that these advances have generated.
authors.affiliation: Department of Medical Oncology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia; ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia.
authors.forename: Desmond
authors.initials: D
authors.lastname: Yip
authors.forename: John
authors.initials: J
authors.lastname: Zalcberg
authors.forename: Stephen
authors.initials: S
authors.lastname: Ackland
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Barbour
authors.forename: Jayesh
authors.initials: J
authors.lastname: Desai
authors.forename: Stephen
authors.initials: S
authors.lastname: Fox
authors.forename: Dusan
authors.initials: D
authors.lastname: Kotasek
authors.forename: Grant
authors.initials: G
authors.lastname: McArthur
authors.forename: B Mark
authors.initials: BM
authors.lastname: Smithers
mesh_terms: D000818:Animals; D019468:Disease Management; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy*; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy*; D006801:Humans; D058990:Molecular Targeted Therapy
keywords: adjuvant; gastrointestinal stromal tumor; imatinib; molecular target therapy; risk stratification