Multidisciplinary Treatment for GIST

Gastrointestinal stromal tumors (GISTs) are relatively rare, requiring a comprehensive knowledge base of various experts in order to provide patients with the best possible care, comments Syma Iqbal, MD. The multidisciplinary approach should include gastroenterologists who are experienced in identifying these tumors, radiologists who are skilled in assessing the density of the lesions on the scans, pathologists who are savvy at knowing what markers to look for, and surgeons who are familiar with surgical techniques used to remove these tumors.

The response rate to the tyrosine kinase inhibitor imatinib for patients with advanced or unresectable GIST is approximately 50%, states Iqbal. Imatinib can be administered in patients who are ineligible for surgical resection in order to shrink the tumor enough so that surgery becomes possible.

There is no clear data regarding the optimal duration of neoadjuvant imatinib, explains Iqbal, noting that patients tend to have responses anywhere from 6 to 12 months following treatment initiation. Tumors may continue to shrink beyond this time point. General guidelines recommend intervening when the patient becomes surgically resectable rather than waiting for maximum response.