Long-term results of adjuvant imatinib mesylate in localized, high-risk, primary gastrointestinal stromal tumor: ACOSOG Z9000 (Alliance) intergroup phase 2 trial

DeMatteo, R. P., Ballman, K. V., Antonescu, C. R., Corless, C., Kolesnikova, V., von Mehren, M., McCarter, M. D., Norton, J., Maki, R. G., Pisters, P. W., Demetri, G. D., Brennan, M. F., Owzar, K., American College of Surgeons Oncology Group Intergroup Adjuvant, Gist Study Team for the Alliance for Clinical Trials in Oncolog (September 2013) Long-term results of adjuvant imatinib mesylate in localized, high-risk, primary gastrointestinal stromal tumor: ACOSOG Z9000 (Alliance) intergroup phase 2 trial. Ann Surg, 258 (3). pp. 422-9. ISSN 1528-1140 (Electronic)0003-4932 (Linking)

URL: https://www.ncbi.nlm.nih.gov/pubmed/23860199
DOI: 10.1097/SLA.0b013e3182a15eb7


OBJECTIVE: To conduct the first adjuvant trial of imatinib mesylate for treatment of gastrointestinal stromal tumor (GIST). BACKGROUND: GIST is the most common sarcoma. Although surgical resection has been the mainstay of therapy for localized, primary GIST, postoperative tumor recurrence is common. The KIT protooncogene or, less frequently, platelet-derived growth factor receptor alpha is mutated in GIST; the gene products of both are inhibited by imatinib mesylate. METHODS: This was a phase II, intergroup trial led by the American College of Surgeons Oncology Group, registered at ClinicalTrials.gov as NCT00025246. From September 2001 to September 2003, we accrued 106 patients who had undergone complete gross tumor removal but were deemed at high risk for recurrence. Patients were prescribed imatinib 400 mg per day for 1 year and followed with serial radiologic evaluation. The primary endpoint was overall survival (OS). RESULTS: After a median follow-up of 7.7 years, the 1-, 3-, and 5-year OS rates were 99%, 97%, and 83%, which compared favorably with a historical 5-year OS rate of 35%. The 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 96%, 60%, and 40%. On univariable analysis, age and mitotic rate were associated with OS. On multivariable analysis, the RFS rate was lower with increasing tumor size, small bowel site, KIT exon 9 mutation, high mitotic rate, and older age. CONCLUSIONS: Adjuvant imatinib in patients with primary GIST who are at high risk of recurrence prolongs OS compared with that of historical controls. Optimal duration of adjuvant therapy remains undefined. (NCT00025246).

Item Type: Paper
Uncontrolled Keywords: Adolescent Adult Aged Antineoplastic Agents/*therapeutic use Benzamides/*therapeutic use Chemotherapy, Adjuvant Drug Administration Schedule Female Follow-Up Studies Gastrointestinal Neoplasms/*drug therapy/mortality/surgery Gastrointestinal Stromal Tumors/*drug therapy/mortality/surgery Humans Imatinib Mesylate Male Middle Aged Neoplasm Recurrence, Local/prevention & control Piperazines/*therapeutic use Pyrimidines/*therapeutic use Risk Survival Analysis Treatment Outcome Young Adult
Subjects: diseases & disorders > cancer > drugs and therapies
diseases & disorders > cancer > cancer types > gastrointestinal stromal tumors
CSHL Authors:
Communities: CSHL labs > Maki lab
Depositing User: Matt Covey
Date: September 2013
Date Deposited: 20 Oct 2016 16:02
Last Modified: 20 Oct 2016 16:02
PMCID: PMC4041735
Related URLs:
URI: https://repository.cshl.edu/id/eprint/33747

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