The Connective Tissue Oncology Society
Download
1 / 11

Barry W. Feig, M.D. Robert S. Benjamin, M.D. The SARCOMA Center - PowerPoint PPT Presentation


  • 168 Views
  • Uploaded on

The Connective Tissue Oncology Society. Surgical Treatment of GIST post Imatinib. Barry W. Feig, M.D. Robert S. Benjamin, M.D. The SARCOMA Center. Chemotherapy + Surgery CR Chemotherapy CR Partial Response Stable Disease. SOFT TISSUE SARCOMAS 1971-1977

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Barry W. Feig, M.D. Robert S. Benjamin, M.D. The SARCOMA Center' - agnes


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

The Connective Tissue Oncology Society

Surgical Treatment of GIST post Imatinib

Barry W. Feig, M.D.

Robert S. Benjamin, M.D.

The SARCOMA Center


Chemotherapy + Surgery CR

Chemotherapy CR

Partial Response

Stable Disease

SOFT TISSUE SARCOMAS 1971-1977

Time to Progression - Distant Metastases

1.00

TOTAL

FAIL

12

37

66

97

9

32

63

96

0.80

0.60

PROPORTION

p = 0.64

p = 0.002

p = 0.002

vs

vs

0.40

vs

0.20

0.00

0

1

2

3

4

5

6

7

8

9

10

YEARS


Gist management of resistance
GIST: Management of Resistance

  • If the majority of tumor is controlled by imatinib mesylate, then continue therapy

  • Dose escalation up to 800-1000 mg/d as tolerated

  • Surgical resection of progressing sites if possible

  • Other trials

Demetri et al. JNCCN. 2004;21(suppl 1):S1.



Time of surgery in imatinib responsive recurrent metastatic gist
TIME OF SURGERY IN IMATINIB RESPONSIVE RECURRENT / METASTATIC GIST

COMPLETE RESECTION

(N=11)

INCOMPLETE RESECTION

(N=18)

SURGERY

SURGERY

PROGRESSION

Median (months) 10.0 18.0 23.7

P=0.04



Gist surgery randomized study
GIST Surgery: Randomized Study METASTATIC GIST

  • Surgery vs No Surgery

  • Surgery at maximum response vs Surgery at first evidence of relapse.


Time of surgery in imatinib responsive recurrent metastatic gist1
TIME OF SURGERY IN IMATINIB RESPONSIVE RECURRENT / METASTATIC GIST

COMPLETE RESECTION

(N=11)

INCOMPLETE RESECTION

(N=18)

SURGERY

SURGERY

PROGRESSION

Median (months) 10.0 18.0 23.7

P=0.04


Time of surgery in imatinib responsive recurrent metastatic gist2
TIME OF SURGERY IN IMATINIB RESPONSIVE RECURRENT / METASTATIC GIST

R

A

N

D

O

M

I

Z

E

EARLY SURGERY

PROGRESSION

DELAYEDSURGERY

Months (estimate) 10 18 20


Gist surgery endpoints
GIST Surgery: Endpoints METASTATIC GIST

  • Time to Progression from start of imatinib

    • If no difference, then surgery does not have a role

    • If TTP longer with early surgery, then surgery is adding

  • Survival

    • If no difference, delayed surgery is preferable (not all will need it).

    • If survival better with early surgery, it is better to do at that time.


The Connective Tissue Oncology Society METASTATIC GIST

Surgical Treatment of GIST post Imatinib

Barry W. Feig, M.D.

Robert S. Benjamin, M.D.

The SARCOMA Center


ad