演題抄録

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開催概要
開催回
第56回・2018年・横浜
 

イマチニブ耐性後の薬物治療効果を最大限に引き出す鍵

演題番号 : PD20-1

[筆頭演者]
演者)村中 徹人:1 
[共同演者]
小松 嘉人:1、中野 真太郎:2、澤田 憲太郎:1、川本 泰之:2、中積 宏之:1、結城 敏志:2、坂本 直哉:2

1:北海道大学病院・腫瘍センター、2:北海道大学病院・消化器内科

 

Imatinib has dramatically changed the treatment of gastrointestinal stromal tumor (GIST). A large number of patients with unresectable advanced GIST can get much better prognosis using imatinib, but we sometimes found patients with advanced GIST which has originally resistance to imatinib such as exon 9 mutation, PDGFR mutation or D842V mutation, or gets acquired resistance such as ATP-binding pocket of exon 13 or 14 and several point mutations on c-kit gene. Sunitinib prolongs the progression free survival (PFS) in the patients with imatinib resistant GIST. But the benefit depends on the gene mutation points of GIST after treatment of imatinib. It was reported that PFS of patients with imatinib resistant GIST which has exon 11 mutation is much shorter than that of the tumor which ha exon 9. Among the GIST with exon 11 mutation, sunitinib shows better effect for the patients whose GIST has the secondary mutation at ATP-biding lesion (exon13 or14) than those with exon 17 or 18 mutations which involve the KIT activation loop. Regorafenib prolongs PFS of the patients with advanced GIST which had resistance in both imatinib and sunitinib. The main adverse events of sunitinib and regorafenib are myelosuppression, hand-foot syndrome, diarrhea, liver dysfunction, fatigue, hypertension, thyroid dysfunction. In addition, we should note that sunitinib has heart toxicity and the liver damage by regorafenib may terminate the patients' life. We must manage these adverse events to make patients to live long with good quality of life.

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