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


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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

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Barry W. Feig, M.D. Robert S. Benjamin, M.D. The SARCOMA Center

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Barry w feig m d robert s benjamin m d the sarcoma center

The Connective Tissue Oncology Society

Surgical Treatment of GIST post Imatinib

Barry W. Feig, M.D.

Robert S. Benjamin, M.D.

The SARCOMA Center


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.


Radiographic response to imatinib in recurrent metastatic gist n 35

RADIOGRAPHIC RESPONSE TO IMATINIB IN RECURRENT / METASTATIC GIST (N=35)


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


Follow up recurrent metastatic gist n 35

FOLLOW-UP RECURRENT / METASTATIC GIST (N=35)


Gist surgery randomized study

GIST Surgery: Randomized Study

  • 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

  • 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.


Barry w feig m d robert s benjamin m d the sarcoma center

The Connective Tissue Oncology Society

Surgical Treatment of GIST post Imatinib

Barry W. Feig, M.D.

Robert S. Benjamin, M.D.

The SARCOMA Center


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