Gastrointestinal stromal tumours: clinical overview, surgery and recent advances in imatinib mesylate therapy

Abstract

Aims: To review the clinical features of gastrointestinal stromal tumours (GISTs), the role of surgery and its principles and molecular targeted therapies.

Methods: A Medline-based literature search on relevant topics was performed in PubMed for key articles concerning the clinical features, biology and the novel strategies in the management, whether surgical and/or pharmaceutical, of gastrointestinal stromal tumours. Some information was obtained from Proceedings of the American Society for Clinical Oncology published recently.

Results: Surgical resection, the first-line intervention for operable GISTs, was historically the only effective treatment. For residual, metastatic and/or inoperable disease, treatment options remain under intense and continuous scrutiny. However, their molecular genetics, i.e. the mutations of the genes coding for KIT or platelet-derived growth factor receptor alpha, two receptor tyrosine kinases, have been targeted for therapeutic intervention by imatinib mesylate -- a tyrosine kinase inhibitor.

Conclusion: Treatment of GISTs with imatinib has led to dramatic improvements in progression-free and overall survival, thereby rendering its use in the preoperative and postoperative treatment under intense investigation. New investigational agents are being developed and participation in promising clinical trials remains a standard of care.