对伊马替尼继发耐药的晚期胃肠道间质瘤治疗策略探讨

Treatment of advanced gastrointestinal stromal tumors acquired resistance to imatinib

目的探讨对伊马替尼继发耐药的复发和转移的晚期胃肠道间质瘤(gastrointestinal stromal tumors,GIST)的治疗策略。方法回顾性分析复旦大学附属中山医院2000—2009年对伊马替尼继发耐药的复发和转移的晚期8例GIST病人的临床资料。结果所有病人均行手术治疗,完整切除原发肿瘤后,肿瘤复发和(或)转移,口服伊马替尼治疗产生继发耐药,采取手术切除复发和转移灶(特别是耐药病灶)联合伊马替尼等靶向治疗为主的综合治疗模式,均获得较好的治疗效果。1例死亡,存活96个月;其余7例仍存活,目前存活时间65～145个月,平均98.6个月。结论伊马替尼继发耐药的复发和转移的晚期GIST,选择手术联合酪氨酸激酶抑制剂靶向治疗为主的多学科综合治疗模式,参考肿瘤的基因状态,采取个体化治疗,可取得较好的疗效。

Objective To discuss and explore the treatment strategy for recurrent and metastatic advanced gastrointestinal stromal tumors （GIST） acquired resistance to imatinib. Methods The clinical data of 8 cases of recurrent and metastatic advanced GIST acquired resistance to imatinib admitted between 2000 and 2009 at Zhongshan Hospital of Fudan University were analyzed retrospectively. Results All cases were performed complete resection of primary tumors, followed by oral administration of imatinib. All cases got acquired resistance to imatinib before or after recurrence and/or metastasis. A comprehensive treatment of surgical resection combined with molecularly targeted therapy was employed with considerably effectiveness in all cases. One case died of recurrence after 96 months of survival time. Other 7 cases survived for 98.6 months of the mean existing survival time （65-145 months）. Conclusion For recurrent and metastatic advanced GIST acquired resistance to imatinib, a multidisciplinary approach, mainly characterized by surgical resection combined with molecularly targeted therapy based on gene features, is an effective treatment strategy, which can offer a better prognosis.