Survival of patients with ruptured gastrointestinal stromal tumour treated with adjuvant imatinib in a randomised trial

• Published in: British journal of cancer Vol. 131; no. 2; pp. 299 - 304
• Main Authors: Joensuu, Heikki, Reichardt, Annette, Eriksson, Mikael, Hohenberger, Peter, Boye, Kjetil, Cameron, Silke, Lindner, Lars H., Jost, Philipp J., Bauer, Sebastian, Schütte, Jochen, Lindskog, Stefan, Kallio, Raija, Jaakkola, Panu M., Goplen, Dorota, Wardelmann, Eva, Reichardt, Peter
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 22-07-2024; Nature Publishing Group
• Subjects: 692/4017; 692/4028/67/1059/602; 692/4028/67/1798; 692/700/565/1436/2185; Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Biomedical and Life Sciences; Biomedicine; Cancer and Oncology; Cancer och onkologi; Cancer Research; Chemotherapy, Adjuvant; Clinical Medicine; Disease-Free Survival; Drug Resistance; Epidemiology; Female; Gastrointestinal cancer; Gastrointestinal Neoplasms - drug therapy; Gastrointestinal Neoplasms - mortality; Gastrointestinal Neoplasms - pathology; Gastrointestinal Stromal Tumors - drug therapy; Gastrointestinal Stromal Tumors - mortality; Gastrointestinal Stromal Tumors - pathology; Gene deletion; Humans; Imatinib; Imatinib Mesylate - therapeutic use; Inhibitor drugs; Klinisk medicin; Male; Medical and Health Sciences; Medical prognosis; Medicin och hälsovetenskap; Middle Aged; Molecular Medicine; Oncology; Patients; Rupture; Rupture, Spontaneous; Survival; Targeted cancer therapy; Tumors
• ISSN: 0007-0920; 1532-1827; 1532-1827
• DOI: 10.1038/s41416-024-02738-z

Background
Patients with ruptured gastrointestinal stromal tumour (GIST) have poor prognosis. Little information is available about how adjuvant imatinib influences survival.
Methods
We explored recurrence-free survival (RFS) and overall survival (OS) of patients with ruptured GIST who participated in a randomised trial (SSG XVIII/AIO), where 400 patients with high-risk GIST were allocated to adjuvant imatinib for either 1 year or 3 years after surgery. Of the 358 patients with confirmed localised GIST, 73 (20%) had rupture reported. The ruptures were classified retrospectively using the Oslo criteria.
Results
Most ruptures were major, four reported ruptures were reclassified unruptured. The 69 patients with rupture had inferior RFS and OS compared with 289 patients with unruptured GIST (10-year RFS 21% vs. 55%, OS 59% vs. 78%, respectively). Three-year adjuvant imatinib did not significantly improve RFS or OS of the patients with rupture compared with 1-year treatment, but in the largest mutational subset with
KIT
exon 11 deletion/indel mutation OS was higher in the 3-year group than in the 1-year group (10-year OS 94% vs. 54%).
Conclusions
About one-fifth of ruptured GISTs treated with adjuvant imatinib did not recur during the first decade of follow-up. Relatively high OS rates were achieved despite rupture.
Clinical Trial Registration
NCT00116935.