title: Key Issues in the Clinical Management of Gastrointestinal Stromal Tumors: An Expert Discussion.
abstract: After the revelation of kinase targeting with orally available small molecules, the use of imatinib in chronic myelogenous leukemia and in gastrointestinal stromal tumor (GIST) has now become commonplace and just two of many examples of the use of kinase inhibitors in cancer. In this article, we discuss important practice points that may impact upon questions of therapy of primary and metastatic GIST, with the hope that the questions addressed in this rare solid tumor can serve as examples of what can be achieved with kinase-directed therapies in other cancers. We present cases that highlight some of the key issues in GIST management and afterward discuss both points of consensus and controversial issues in what is now recognized as one of the most common forms of sarcoma.
  
  
  CONCLUSIONS
  The treatment of gastrointestinal stromal tumor (GIST) has become sophisticated with the availability of three approved agents in many countries and 15 years of experience with primary and metastatic disease. Important lessons from tyrosine-kinase inhibitors in GIST can be gleaned from this experience and will impact implementation of similar agents for other cancers.
authors.affiliation: Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA; Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain; National Cancer Center Hospital East, Department of Surgery, Kashiwa, Japan; HELIOS Klinikum Berlin-Buch, Interdisciplinary Oncology, Berlin, Germany; General Medical Oncology, Leuven Cancer Institute, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium; University of Miami Sylvester Cancer Center, Sarcoma Medical Oncology Program, Miami, Florida, USA bobmakimd@gmail.com.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Maki
authors.affiliation: Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA; Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain; National Cancer Center Hospital East, Department of Surgery, Kashiwa, Japan; HELIOS Klinikum Berlin-Buch, Interdisciplinary Oncology, Berlin, Germany; General Medical Oncology, Leuven Cancer Institute, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium; University of Miami Sylvester Cancer Center, Sarcoma Medical Oncology Program, Miami, Florida, USA.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.affiliation: Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA; Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain; National Cancer Center Hospital East, Department of Surgery, Kashiwa, Japan; HELIOS Klinikum Berlin-Buch, Interdisciplinary Oncology, Berlin, Germany; General Medical Oncology, Leuven Cancer Institute, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium; University of Miami Sylvester Cancer Center, Sarcoma Medical Oncology Program, Miami, Florida, USA.
authors.forename: George D
authors.initials: GD
authors.lastname: Demetri
authors.affiliation: Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA; Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain; National Cancer Center Hospital East, Department of Surgery, Kashiwa, Japan; HELIOS Klinikum Berlin-Buch, Interdisciplinary Oncology, Berlin, Germany; General Medical Oncology, Leuven Cancer Institute, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium; University of Miami Sylvester Cancer Center, Sarcoma Medical Oncology Program, Miami, Florida, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fletcher
authors.affiliation: Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA; Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain; National Cancer Center Hospital East, Department of Surgery, Kashiwa, Japan; HELIOS Klinikum Berlin-Buch, Interdisciplinary Oncology, Berlin, Germany; General Medical Oncology, Leuven Cancer Institute, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium; University of Miami Sylvester Cancer Center, Sarcoma Medical Oncology Program, Miami, Florida, USA.
authors.forename: Heikki
authors.initials: H
authors.lastname: Joensuu
authors.affiliation: Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA; Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain; National Cancer Center Hospital East, Department of Surgery, Kashiwa, Japan; HELIOS Klinikum Berlin-Buch, Interdisciplinary Oncology, Berlin, Germany; General Medical Oncology, Leuven Cancer Institute, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium; University of Miami Sylvester Cancer Center, Sarcoma Medical Oncology Program, Miami, Florida, USA.
authors.forename: Javier
authors.initials: J
authors.lastname: Martín-Broto
authors.affiliation: Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA; Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain; National Cancer Center Hospital East, Department of Surgery, Kashiwa, Japan; HELIOS Klinikum Berlin-Buch, Interdisciplinary Oncology, Berlin, Germany; General Medical Oncology, Leuven Cancer Institute, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium; University of Miami Sylvester Cancer Center, Sarcoma Medical Oncology Program, Miami, Florida, USA.
authors.forename: Toshirou
authors.initials: T
authors.lastname: Nishida
authors.affiliation: Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA; Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain; National Cancer Center Hospital East, Department of Surgery, Kashiwa, Japan; HELIOS Klinikum Berlin-Buch, Interdisciplinary Oncology, Berlin, Germany; General Medical Oncology, Leuven Cancer Institute, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium; University of Miami Sylvester Cancer Center, Sarcoma Medical Oncology Program, Miami, Florida, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Reichardt
authors.affiliation: Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA; Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain; National Cancer Center Hospital East, Department of Surgery, Kashiwa, Japan; HELIOS Klinikum Berlin-Buch, Interdisciplinary Oncology, Berlin, Germany; General Medical Oncology, Leuven Cancer Institute, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium; University of Miami Sylvester Cancer Center, Sarcoma Medical Oncology Program, Miami, Florida, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Schöffski
authors.affiliation: Tisch Cancer Institute, Mount Sinai Medical Center, New York, New York, USA; Department of Medical Oncology, Centre Léon Bérard, Lyon, France; Dana-Farber Cancer Institute, Boston, Massachusetts, USA; Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA; Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Servicio de Oncología Médica, Fundación Instituto Valenciano de Oncología, Valencia, Spain; National Cancer Center Hospital East, Department of Surgery, Kashiwa, Japan; HELIOS Klinikum Berlin-Buch, Interdisciplinary Oncology, Berlin, Germany; General Medical Oncology, Leuven Cancer Institute, University Hospital Gasthuisberg, Catholic University Leuven, Leuven, Belgium; University of Miami Sylvester Cancer Center, Sarcoma Medical Oncology Program, Miami, Florida, USA.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Trent
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D006801:Humans; D000068877:Imatinib Mesylate / Q000627:therapeutic use; D008297:Male
chemical_list: D000970:Antineoplastic Agents; D000068877:Imatinib Mesylate
keywords: Carney-Stratakis syndrome; GIST; Gastrointestinal stromal tumor; Imatinib; KIT; PDGFRA; Regorafenib; SDH; Sunitinib