Systemic Therapy
Imatinib - Monitoring
As Glivec therapy for GIST has become the standard of care (Figure 1),1-5 attention has been increasingly focused on questions related to optimal management.
Glivec dosing
The recommended dose of Glivec is 400 mg/d for patients with unresectable and/or metastatic malignant GIST.6 There are currently no data available to support specific dosing recommendations for GIST patients based on prior GI resection. The majority (98%) of patients in the clinical trial (see phase 2 trial B2222) had undergone prior resection. For all patients in the study, there was at least a 2-week interval between resection and the first doses of Glivec administered. However, no additional recommendations can be made based on this study.
Figure 1 - GIST treatment algorithm
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GIST treatment algorithm. Adapted with permission from Reichardt P. Eur J Cancer. 2006;4(suppl 1):19-26.2
References:
1. Blay JY, Bonvalot S, Casali P, et al. Consensus meeting for the management of gastrointestinal stromal tumors. Report of the GIST Consensus Conference of 20-21 March 2004, under the auspices of European Society for Medical Oncology. Ann Oncol. 2005;16:566-578.
2. Reichardt P. Optimising therapy for GIST patients. Eur J Cancer. 2006;4(suppl 1):19-26.
3. Blackstein ME, Rankin C, Fletcher C, et al. Clinical benefits of imatinib in patients (pts) with metastatic gastrointestinal stromal tumors (GIST) negative for the expression of CD117 in the S0033 trial [abstract]. J Clin Oncol. 2005;23:818s. Abstract 9010.
4. Rutkowski P, Nowecki Z, Nyckowski P, et al. Surgical treatment for patients (pts) with gastrointestinal stromal tumors (GIST) after imatinib mesylate (IM) therapy [abstract]. J Clin Oncol. 2005;23:825s Abstract 9037.
5. Gronchi A, Fiore M, Bertulli R, et al. Surgery of residual disease following imatinib mesylate in advanced gastrointestinal stromal tumors (GIST) [abstract]. J Clin Oncol. 2005;23:825s. Abstract 9038.
6. Glivec summary of product characteristics [SMPC]. Basel, Switzerland: Novartis Pharma AG; 2006.