Treatment of patients with advanced gastrointestinal stromal tumor of small bowel: Implications of imatinib mesylate

瞄准：检验 imatinib 的影响耐心的幸存和反应和它的安全上的 mesylate (Glivec ) ，和反应的关联与工具包基因变化地位评价。方法：74 中的 33 个(44.6%) 在药品切除术以后并且不开发了复发的胃肠的基质肿瘤(大意) 病人与 Glivec 对待的小肠是被分类组 A 病人。与 Glivec 对待的 22 个先进的小肠大意病人作为组 B 病人被分类。Clinicopathological 特征，复发以后、全面的幸存率被比较。在组 B 病人的每个肿瘤为工具包或导出血小板的生长因素高山的变化被调查哈(PDGFRA ) 。变化类型与临床的结果被相关。在组 B 病人的 Glivec 的反肿瘤效果和安全也被估计。结果：与 Glivec 对待的先进的小肠大意病人比没与 Glivec 对待的那些有 substatntially 更长的复发以后的幸存和更高全面的幸存率。15 个病人的一个总数有部分回答(PR )(67.8%) 。c 工具包的激活的变化在 19 个测试病人中的 16 个被发现，没有 PDGFRA 异种被识别。在有在 11 个工具包变化上怀有前的大意的 13 个病人，部分反应率(PR ) 是 69.3% ，而有在 9 工具包变化上包含前的肿瘤的三个病人中的二个有 66.7% 的全面反应率(ORR )( 不重要) 。结论：Glivec 显著地与先进大意延长亚洲病人的复发以后、全面的幸存。Glivec 导致持续客观回答在多于有先进的小肠大意的亚洲病人的一半。11 上的工具包前的激活的变化在绝大多数大意是可检测的。在 11 个变化上处于为其大意在 9 上有工具包前的病人和前的 PR 率没有差别。

AIM： To examine the impact of imatinib mesylate （Glivec） on patient survival and response and its safety, and the correlation of the response rate with the kit gene mutation status. METHODS： Thirty-three of 74 （44.6%） small bowel gastrointestinal stromal tumor （GIST） patients who developed recurrence after curative resection and not treated with Glivec were classified as group A patients. Twenty-two advanced small bowel GIST patients treated with Glivec were classified as group B patients. Clinicopathological features, post-recurrence and overall survival rates were compared. Each tumor in group B patients was investigated for mutations of kit or plateletderived growth factor alpha （PDGFRA）. The mutation type was correlated with clinical outcomes. The antitumor effect and safety of Glivec in group B patients were also assessed. RESULTS： Advanced small bowel GIST patients treated with Glivec had substatntially longer post-recurrence survival and higher overall survival rates than those not treated with Glivec. A total of 15 patients had a partial response （PR） （67.8%）. Activated mutations of c-kit were found in 16 of 19 tested patients and no PDGFRA mutant was identified. In 13 patients with GISTs harboring exon 11 kit mutations, the partial response rate （PR） was 69.3%, whereas two of three patients with tumors containing an exon 9 kit mutation had an overall response rate （ORR） of 66.7% （not significant）. CONCLUSION： Glivec significantly prolongs the postrecurrence and overall survival of Asian patients with advanced GISTs. Glivec induces a sustained objective response in more than half of Asian patients withadvanced small bowel GISTs. Activated mutations of kit exon 11 are detectable in the vast majority of GISTs. There is no difference in the PR rate for patients whose GISTs have kit exon 9 and exon 11 mutations.