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開催概要
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第56回・2018年・横浜
 

チロシンキナーゼ阻害剤部分耐性GISTに対する外科治療:適応と限界

演題番号 : PD20-2

[筆頭演者]
演者)菊池 寛利:1 
[共同演者]
平松 良浩:1,2、神谷 欣志:1、森田 剛文:1、坂口 孝宣:1、竹内 裕也:1

1:浜松医科大学・第二外科、2:浜松医科大学・周術期等生活機能支援学

 

Although imatinib (IM) is a standard treatment for metastatic or recurrent gastrointestinal stromal tumors (GISTs), acquired c-kit mutations reportedly cause secondary resistance to IM in about half of patients within 2 years. Sunitinib (SU) is a tyrosine kinase inhibitor (TKI) that can be used as second-line therapy in IM-resistant or -intolerant GISTs. However, median time to tumor progression was 6.8 months in patients treated with SU and most patients developed resistance or intolerance to SU. For SU-resistant or -intolerant GISTs, regorafenib (RE) is a standard third-line treatment. Although median progression-free survival (PFS) was significantly improved with RE vs placebo control (4.8 vs 0.9 month), most patients develope resistance or intolerance to RE within a year. Therefore, role of cytoreductive surgery for GISTs resistant to TKIs has been discussed. Most retrospective studies of cytoreductive surgery during IM therapy indicate that PFS and overall survival (OS) were longer after surgery for patients with limited resistance to IM than for patients with systemic resistance. Cytoreductive surgery may be indicated in limited disease progression refractory to IM when complete resection is possible, however; case selection is critical and safety and efficiency remain controversial. In addition, the survival benefit of cytoreductive surgery for IM-resistant GIST appears to be affected by postoperative course including the continuous administration of IM after complete resection of IM-resistant GIST and the administration of SU and RE after developing 2nd recurrence. Cytoreductive surgery for patients with GIST on SU seem infeasible because of high rates of incomplete resections and complications, and may be indicated only for management of symptomatic bleeding or obstruction. Cytoreductive surgery for TKI-resistant GIST warrants detailed investigations at hospitals and institutions with significant experience of multidisciplinary treatment for advanced GISTs.

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