Treatment Options for Gastrointestinal Stromal Tumors

Ask Your Doctor About These Options

Treatment options for gastrointestinal stromal tumors (GISTs) often require an individualized multidisciplinary approach. It’s important to discuss the benefits and risks of each treatment option with your oncologist to determine the most effective treatment plan.

Common treatment options include the following.

Surgery

If the tumor is localized and operable, surgery is often the first line of treatment for GIST. The goal of surgery is to completely remove the tumor along with a margin of healthy surrounding tissue to ensure that all cancer cells are removed.

Surgery can be performed laparoscopically, using small incisions, resulting in decreased pain and a quicker recovery time, or open, using larger incisions, which is often necessary for larger or more complex tumors. The success of surgical treatment for GIST depends on the size and location of the tumor, as well as if it has metastasized. For small, localized tumors, surgery can be curative.

Targeted Therapy

This treatment involves using drugs that target specific abnormal proteins produced by cancer cells. This type of treatment is particularly effective for GIST, as most of these tumors have mutations in the KIT or PDGFRA genes.

The best-targeted therapies for GIST include:

• Imatinib. This drug targets the KIT protein, thereby blocking the signals that cause cancer cells to grow. It's the first-line treatment for unresectable tumors or tumors that have spread (metastasized).
• Sunitinib. This drug targets multiple proteins in cancer cell growth and angiogenesis. It's used when Imatinib is ineffective or if an individual develops resistance to Imatinib.
• Regorafenib. This drug inhibits several kinases involved in tumor growth and angiogenesis. It's used in patients whose tumors have progressed after treatment with imatinib and sunitinib.
• Ripretinib. This drug inhibits KIT and PDGFRA mutations. It's a new treatment option that is available for individuals who have exhausted other targeted therapy options.
• Radiation therapy. Radiation therapy rarely plays a role in the management of GISTs. Occasionally, it may be used for palliative care in individuals that have painful metastasis or for those with unresectable bleeding tumors.

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Adjuvant Options

Adjuvant therapy refers to additional treatment that is given after the primary treatment, which is usually surgery, to reduce the risk of cancer recurrence. For GIST, adjuvant therapy often involves using a targeted drug, such as imatinib, for a certain period, depending on your risk of recurrence, which is determined by tumor size, location and mitotic rate.

Neoadjuvant Options

Neoadjuvant therapy refers to treatment that is given before the primary treatment, which is usually surgery, to shrink the tumor and make it more manageable to resect. For GIST, neoadjuvant therapy often uses imatinib.

Surveillance and Follow-up

Surveillance and regular follow-up are important pieces of managing GIST effectively. After the initial treatment of your tumor, you will require regular follow-ups to monitor for cancer recurrence or metastasis. This often includes regular physical examinations and imaging, such as CT or MRI.

The frequency of your follow-up visits will depend on your risk of cancer recurrence and your overall health status.

Clinical Trials

If you have GIST and your tumor is not responding to standard treatment, you should speak to your oncologist about enrolling in a clinical trial. Clinical trials offer patients access to new and potentially more effective treatments that are not widely available.

Supportive Care

Supportive care is an essential part of GIST treatment that is often overlooked. It focuses on alleviating pain and discomfort and improving your overall quality of life. Supportive care can include pain management, nutritional support and psychological counselling.

Final Notes

GISTs are often challenging to treat, but treatment options have evolved significantly in recent years. While surgery remains the first-line option for localized tumors, targeted therapies have shown to be effective for metastatic and recurrent tumors.

If you’ve recently been diagnosed with GIST, it can be overwhelming. Talk to your doctor to develop a plan that meets your needs.

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