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Yokoyama K, Tsuchiya J, Nakamoto Y, Tateishi U. Additional Value of [ 18F]FDG PET or PET/CT for Response Assessment of Patients with Gastrointestinal Stromal Tumor Undergoing Molecular Targeted Therapy: A Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11030475. [PMID: 33800310 PMCID: PMC8000740 DOI: 10.3390/diagnostics11030475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/04/2021] [Accepted: 03/05/2021] [Indexed: 12/12/2022] Open
Abstract
To assess the additional value of 2-deoxy-2-[18F] fluoro-d-glucose ([18F]FDG) positron emission tomography (PET) or PET/CT over conventional morphological imaging techniques in the treatment response assessment of gastrointestinal stromal tumor (GIST) to molecular targeted therapy (MTT), we performed a meta-analysis of all the available studies to compare the predictive value of [18F]FDG PET or PET/CT and conventional imaging techniques for assessing the response to MTT in GIST. We determined the sensitivities and specificities across studies, we calculated the positive and negative likelihood ratios (LR) and made summary receiver operating characteristic curves (SROC) using hierarchical regression models. Pooled analysis included 4 studies comprising 88 patients. The performance characteristics in [18F]FDG PET or PET/CT and CT were as follows: sensitivity, 89% (95% confidence interval (CI) 78, 95), 52% (39, 64); specificity, 65% (44, 83), 92% (75, 99); diagnostic odds ratios (DOR), 5.8 (2.0, 16.8 4.9 (1.5, 16.1); positive LR, 1.9 (1.1, 3.4), 3.0 (1.1, 8.1); and negative LR, 0.23 (0.03, 1.6), 0.66 (0.42, 1.0), respectively. In SROC curves, the area under the curve (AUC) was 0.81 (SE, 0.11) and 0.71 (SE, 0.13) and the Q* index was 0.74 and 0.66, respectively. [18F]FDG PET/CT had higher sensitivity, while DOR and SROC curves showed better diagnostic performance in [18F]FDG PET and PET/CT studies as compared to CT.
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Affiliation(s)
- Kota Yokoyama
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (J.T.); (U.T.)
- Correspondence: ; Tel.: +81-3-5803-5311; Fax: +81-3-5803-0147
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (J.T.); (U.T.)
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto 606-8507, Japan;
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, Tokyo 113-8510, Japan; (J.T.); (U.T.)
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Obata Y, Hara Y, Shiina I, Murata T, Tasaki Y, Suzuki K, Ito K, Tsugawa S, Yamawaki K, Takahashi T, Okamoto K, Nishida T, Abe R. N822K- or V560G-mutated KIT activation preferentially occurs in lipid rafts of the Golgi apparatus in leukemia cells. Cell Commun Signal 2019; 17:114. [PMID: 31484543 PMCID: PMC6727407 DOI: 10.1186/s12964-019-0426-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/22/2019] [Indexed: 02/07/2023] Open
Abstract
Background KIT tyrosine kinase is expressed in mast cells, interstitial cells of Cajal, and hematopoietic cells. Permanently active KIT mutations lead these host cells to tumorigenesis, and to such diseases as mast cell leukemia (MCL), gastrointestinal stromal tumor (GIST), and acute myeloid leukemia (AML). Recently, we reported that in MCL, KIT with mutations (D816V, human; D814Y, mouse) traffics to endolysosomes (EL), where it can then initiate oncogenic signaling. On the other hand, KIT mutants including KITD814Y in GIST accumulate on the Golgi, and from there, activate downstream. KIT mutations, such as N822K, have been found in 30% of core binding factor-AML (CBF-AML) patients. However, how the mutants are tyrosine-phosphorylated and where they activate downstream molecules remain unknown. Moreover, it is unclear whether a KIT mutant other than KITD816V in MCL is able to signal on EL. Methods We used leukemia cell lines, such as Kasumi-1 (KITN822K, AML), SKNO-1 (KITN822K, AML), and HMC-1.1 (KITV560G, MCL), to explore how KIT transduces signals in these cells and to examine the signal platform for the mutants using immunofluorescence microscopy and inhibition of intracellular trafficking. Results In AML cell lines, KITN822K aberrantly localizes to EL. After biosynthesis, KIT traffics to the cell surface via the Golgi and immediately migrates to EL through endocytosis in a manner dependent on its kinase activity. However, results of phosphorylation imaging show that KIT is preferentially activated on the Golgi. Indeed, blockade of KITN822K migration to the Golgi with BFA/M-COPA inhibits the activation of KIT downstream molecules, such as AKT, ERK, and STAT5, indicating that KIT signaling occurs on the Golgi. Moreover, lipid rafts in the Golgi play a role in KIT signaling. Interestingly, KITV560G in HMC-1.1 migrates and activates downstream in a similar manner to KITN822K in Kasumi-1. Conclusions In AML, KITN822K mislocalizes to EL. Our findings, however, suggest that the mutant transduces phosphorylation signals on lipid rafts of the Golgi in leukemia cells. Unexpectedly, the KITV560G signal platform in MCL is similar to that of KITN822K in AML. These observations provide new insights into the pathogenic role of KIT mutants as well as that of other mutant molecules. Electronic supplementary material The online version of this article (10.1186/s12964-019-0426-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuuki Obata
- Division of Immunobiology, Research Institute for Biomedical Sciences, Tokyo University of Science, Yamazaki 2669, Noda, Chiba, 278-0022, Japan. .,Division of Cancer Differentiation, National Cancer Center Research Institute, Tsukiji 5-1-1, Chuo-ku, 104-0045, Tokyo, Japan.
| | - Yasushi Hara
- Division of Immunobiology, Research Institute for Biomedical Sciences, Tokyo University of Science, Yamazaki 2669, Noda, Chiba, 278-0022, Japan
| | - Isamu Shiina
- Department of Applied Chemistry, Faculty of Science, Tokyo University of Science, Kagurazaka 1-3, Shinjuku-ku, 162-8601, Tokyo, Japan
| | - Takatsugu Murata
- Department of Applied Chemistry, Faculty of Science, Tokyo University of Science, Kagurazaka 1-3, Shinjuku-ku, 162-8601, Tokyo, Japan
| | - Yasutaka Tasaki
- Department of Applied Chemistry, Faculty of Science, Tokyo University of Science, Kagurazaka 1-3, Shinjuku-ku, 162-8601, Tokyo, Japan
| | - Kyohei Suzuki
- Department of Applied Chemistry, Faculty of Science, Tokyo University of Science, Kagurazaka 1-3, Shinjuku-ku, 162-8601, Tokyo, Japan
| | - Keiichi Ito
- Department of Applied Chemistry, Faculty of Science, Tokyo University of Science, Kagurazaka 1-3, Shinjuku-ku, 162-8601, Tokyo, Japan
| | - Shou Tsugawa
- Division of Cancer Differentiation, National Cancer Center Research Institute, Tsukiji 5-1-1, Chuo-ku, 104-0045, Tokyo, Japan.,Department of Applied Chemistry, Faculty of Science, Tokyo University of Science, Kagurazaka 1-3, Shinjuku-ku, 162-8601, Tokyo, Japan
| | - Kouhei Yamawaki
- Division of Cancer Differentiation, National Cancer Center Research Institute, Tsukiji 5-1-1, Chuo-ku, 104-0045, Tokyo, Japan
| | - Tsuyoshi Takahashi
- Department of Surgery, Osaka University, Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Koji Okamoto
- Division of Cancer Differentiation, National Cancer Center Research Institute, Tsukiji 5-1-1, Chuo-ku, 104-0045, Tokyo, Japan
| | - Toshirou Nishida
- National Cancer Center Hospital, Tsukiji 5-1-1, Chuo-ku, 104-0045, Tokyo, Japan
| | - Ryo Abe
- Division of Immunobiology, Research Institute for Biomedical Sciences, Tokyo University of Science, Yamazaki 2669, Noda, Chiba, 278-0022, Japan. .,SIRC, Teikyo University, Itabashi-ku 2-11-1, Itabashi-ku, 173-8605, Tokyo, Japan.
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Bertucci F, Finetti P, De Nonneville A, Birnbaum D. "Wnt/β-Catenin in GIST"-Letter. Mol Cancer Ther 2018; 17:327-328. [PMID: 29295963 DOI: 10.1158/1535-7163.mct-17-0948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022]
Abstract
In an article published on September, 2017, in Molecular Cancer Therapeutics, Zeng and colleagues showed that the WNT/β-catenin oncogenic pathway was activated in a subset of human gastrointestinal stromal tumors (GIST) and that inhibiting its signaling alone or in combination with imatinib has antitumor efficacy in vitro and in vivo in imatinib-sensitive and resistant preclinical models. However, they concluded that "more investigation is needed to correlate β-catenin activation with clinicopathologic features in GIST clinical samples." Here, we examined the activation score of the β-catenin pathway in 160 clinically annotated clinical samples of operated primary GISTs. We showed that the β-catenin activation score, assessed as continuous variable, was heterogeneous across samples. Higher score was associated with certain prognostic clinicopathologic characteristics, including mutational status, tumor size, and AFIP classification, and even more importantly, with more postoperative relapses in uni- and multivariate analyses. Such unfavorable independent prognostic value of β-catenin activation reinforces the potential therapeutic value of this new target in GIST and nicely complements Zeng's study. Mol Cancer Ther; 17(1); 327-8. ©2018 AACR.
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Affiliation(s)
- François Bertucci
- Department of Molecular Oncology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR7258, Marseille, France.
| | - Pascal Finetti
- Department of Molecular Oncology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR7258, Marseille, France
| | - Alexandre De Nonneville
- Department of Molecular Oncology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR7258, Marseille, France
| | - Daniel Birnbaum
- Department of Molecular Oncology, Centre de Recherche en Cancérologie de Marseille, Institut Paoli-Calmettes, INSERM UMR1068, CNRS UMR7258, Marseille, France
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Prause M, Niedermoser S, Schirrmacher R, Wängler C, Wängler B. Synthetic approaches towards [18F]fluoro-DOG1, a potential radiotracer for the imaging of gastrointestinal stromal tumors. Tetrahedron Lett 2018. [DOI: 10.1016/j.tetlet.2018.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rohrabaugh TN, Rohrabaugh AM, Kodanko JJ, White JK, Turro C. Photoactivation of imatinib-antibody conjugate using low-energy visible light from Ru(ii)-polypyridyl cages. Chem Commun (Camb) 2018; 54:5193-5196. [PMID: 29707728 DOI: 10.1039/c8cc01348a] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ru(ii)-polypyridyl cages with sterically bulky bidentate ligands provide efficient photochemical release of the anticancer drug imatinib using low energy visible light, imparting spatiotemporal control over drug bioavailability. The light-activated drug release is maintained when the Ru(ii) cage is covalently coupled to an antibody, which is expected to localize selectively on the tumor.
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Affiliation(s)
- Thomas N Rohrabaugh
- Department of Chemistry and Biochemistry, The Ohio State University, Columbus, OH 43210, USA.
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Rosa F, Alfieri S, Tortorelli AP, Di Miceli D, Papa V, Doglietto GB. Gastrointestinal Stromal Tumors: Prognostic Factors and Therapeutic Implications. TUMORI JOURNAL 2018; 98:351-6. [DOI: 10.1177/030089161209800312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of the digestive tract. They have recently been recognized as a separate nosological entity and the literature on these stromal tumors has rapidly expanded. Materials and methods The surgical records of 50 patients with primary GISTs treated at the Digestive Surgery Department of the Catholic University of Rome from January 1993 to December 2010 were reviewed and the prognostic factors were analyzed. Results Surgery was performed in all patients with curative intent. The median age at presentation was 66.5 years (range, 28–81). Adjuvant therapy was administered in 26 (52%) cases. Median follow-up was 71 months (range, 5–208). There was an 8% recurrence rate. The actuarial 5-year overall and disease-free survival rates were 66.3% and 57.2%, respectively. High mitotic rate (P <0.001), tumor size greater than 10 cm (P = 0.007) and tumor rupture (P = 0.05) were the only prognostically significant negative factors for overall survival in multivariate analysis. Conclusions The present study confirmed the important role of aggressive surgical management of GISTs to offer these patients the most appropriate treatment for long-term survival.
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Affiliation(s)
- Fausto Rosa
- Department of Digestive Surgery, Agostino Gemelli
Hospital, Catholic University of Rome, Rome, Italy
| | - Sergio Alfieri
- Department of Digestive Surgery, Agostino Gemelli
Hospital, Catholic University of Rome, Rome, Italy
| | - Antonio Pio Tortorelli
- Department of Digestive Surgery, Agostino Gemelli
Hospital, Catholic University of Rome, Rome, Italy
| | - Dario Di Miceli
- Department of Digestive Surgery, Agostino Gemelli
Hospital, Catholic University of Rome, Rome, Italy
| | - Valerio Papa
- Department of Digestive Surgery, Agostino Gemelli
Hospital, Catholic University of Rome, Rome, Italy
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Synthesis, in vitro and in vivo evaluation of 18F-fluoronorimatinib as radiotracer for Imatinib-sensitive gastrointestinal stromal tumors. Nucl Med Biol 2017; 57:1-11. [PMID: 29175467 DOI: 10.1016/j.nucmedbio.2017.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/03/2017] [Accepted: 11/15/2017] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GIST) have a wide range of mutations, but can mostly be treated with Imatinib, until eventually resistance towards this tyrosine kinase inhibitor is acquired. Early and non-invasive determination of the sensitivity of the tumor and its metastases towards Imatinib by positron emission tomography (PET) would be beneficial for therapy planning and monitoring. METHODS We developed a synthesis strategy towards the precursor molecule, performed the 18F-synthesis and in the following evaluated the radioligand in vitro regarding its lipophilicity, stability and biological activity (KIT binding properties) as well as its in vivo properties in GIST tumor-bearing mice. RESULTS [18F]fluoronorimatinib could be obtained in an overall radiochemical yield of 22.2±3.3% within 90min. The radioligand showed high GIST cell uptake and was able to distinguish between Imatinib-sensitive and resistant tumor cell lines (GIST-T1, GIST882, GIST430) in vitro. Further biological evaluations of the ligand towards 9 different GIST-relevant KIT mutations showed comparable binding affinities compared to the structural lead Norimatinib (65nM vs. 53nM for wt-KIT). The in vivo evaluation of the newly developed radioligand showed tumor-to-background-ratios comparable to previously described, similar radiotracers. CONCLUSIONS Thus, [18F]fluoronorimatinib is able to distinguish between Imatinib-resistant and sensitive KIT mutations. Although no improvement of in vivo tumor-to-background ratios could be achieved compared to formerly described radioligands, the hepatic uptake could be considerably reduced, being advantageous for the imaging of GIST. Advances in knowledge and implications for patient care: We were able to show that it is possible to significantly reduce the unfavorably high hepatic uptake of small-molecule radioligands applicable for GIST PET imaging. This work can thus be the basis for further work intending to develop a PET-radioligand for Imatinib-dependent GIST imaging.
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Lee J, Park D, Lee Y. Metformin Synergistically Potentiates the Antitumor Effects of Imatinib in Colorectal Cancer Cells. Dev Reprod 2017; 21:139-150. [PMID: 28785735 PMCID: PMC5532306 DOI: 10.12717/dr.2017.21.2.139] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 04/15/2017] [Accepted: 04/18/2017] [Indexed: 12/27/2022]
Abstract
Metformin is the most commonly prescribed anti-diabetic drug with relatively
minor side effect. Substantial evidence has suggested that metformin is
associated with decreased cancer risk and anticancer activity against diverse
cancer cells. The tyrosine kinase inhibitor imatinib has shown powerful activity
for treatment of chronic myeloid leukemia and also induces growth arrest and
apoptosis in colorectal cancer cells. In this study, we tested the combination
of imatinib and metformin against HCT15 colorectal cancer cells for effects on
cell viability, cell cycle and autophagy. Our data show that metformin
synergistically enhances the imatinib cytotoxicity in HCT15 cells as indicated
by combination and drug reduction indices. We also demonstrate that the
combination causes synergistic down-regulation of pERK, cell cycle arrest in S
and G2/M phases via reduction of cyclin B1 level. Moreover, the
combination resulted in autophagy induction as revealed by increased acidic
vesicular organelles and cleaved form of LC3-II. Inhibition of autophagic
process by chloroquine led to decreased cell viability, suggesting that
induction of autophagy seems to play a cell protective role that may act against
anticancer effects. In conclusion, our present data suggest that metformin in
combination with imatinib might be a promising therapeutic option in colorectal
cancer.
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Affiliation(s)
- Jaeryun Lee
- Dept. of Medicine, Jeju National University School of Medicine, Jeju 690-756, Korea
| | - Deokbae Park
- Dept. of Histology, Jeju National University School of Medicine, Jeju 690-756, Korea
| | - Youngki Lee
- Dept. of Histology, Jeju National University School of Medicine, Jeju 690-756, Korea
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Hu S, Yuan H, Li Z, Zhang J, Wu J, Chen Y, Shi Q, Ren W, Shao N, Ying X. Transcriptional response profiles of paired tumor-normal samples offer novel perspectives in pan-cancer analysis. Oncotarget 2017; 8:41334-41347. [PMID: 28489584 PMCID: PMC5522216 DOI: 10.18632/oncotarget.17295] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 04/03/2017] [Indexed: 01/05/2023] Open
Abstract
Both tumor and adjacent normal tissues are valuable in cancer research. Transcriptional response profiles represent the changes of gene expression levels between paired tumor and adjacent normal tissues. In this study, we performed a pan-cancer analysis based on the transcriptional response profiles from 633 samples across 13 cancer types. We obtained two interesting results. Using consensus clustering method, we characterized ten clusters with distinct transcriptional response patterns and enriched pathways. Notably, head and neck squamous cell carcinoma was divided in two subtypes, enriched in cell cycle-related pathways and cell adhesion-related pathways respectively. The other interesting result is that we identified 92 potential pan-cancer genes that were consistently upregulated across multiple cancer types. Knockdown of FAM64A or TROAP inhibited the growth of cancer cells, suggesting that these genes may promote tumor development and are worthy of further validations. Our results suggest that transcriptional response profiles of paired tumor-normal tissues can provide novel perspectives in pan-cancer analysis.
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Affiliation(s)
- Shuofeng Hu
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Hanyu Yuan
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Zongcheng Li
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
- Translational Medicine Center of Stem Cells, 307-Ivy Translational Medicine Center, Laboratory of Oncology, Affiliated Hospital, Academy of Military Medical Sciences, Beijing 100071, China
| | - Jian Zhang
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Jiaqi Wu
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Yaowen Chen
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
- Department of Obstetrics and Gynecology, Fuzhou General Hospital of Nanjing Military Command, Fujian 350025, China
| | - Qiang Shi
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Wu Ren
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Jilin University, Changchun 130021, China
| | - Ningsheng Shao
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
| | - Xiaomin Ying
- Beijing Institute of Basic Medical Sciences, Beijing 100850, China
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Dimitrakopoulou-Strauss A, Ronellenfitsch U, Cheng C, Pan L, Sachpekidis C, Hohenberger P, Henzler T. Imaging therapy response of gastrointestinal stromal tumors (GIST) with FDG PET, CT and MRI: a systematic review. Clin Transl Imaging 2017; 5:183-197. [PMID: 29104864 PMCID: PMC5658474 DOI: 10.1007/s40336-017-0229-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/17/2017] [Indexed: 12/14/2022]
Abstract
Purpose Improvement of the therapeutic approaches in gastrointestinal stromal tumors (GIST) by the introduction of targeted therapies requires appropriate diagnostic tools, which allow sufficient assessment of therapeutic response, including differentiation of true progression from pseudoprogression due to myxoid degeneration or intratumoral hemorrhage. In this literature review the impact and limitations of different imaging modalities used in GIST therapy monitoring are discussed. Methods PubMed and Cochrane library search were performed using appropriate keywords. Overall, 39 original papers fulfilled the defined criteria and were included in this systematic review. Results Morphological imaging modalities like computed tomography (CT) are primarily used for both diagnosis and therapy monitoring. However, therapy with tyrosine kinase inhibitors and other targeted therapies in GIST may lead only to a minor tumor volume reduction even in cases of response. Therefore, the use of Response Evaluation Criteria in Solid Tumors (RECIST) has limitations. To overcome those limitations, modified response criteria have been introduced for the CT-based therapy assessment, like the Choi criteria as well as criteria based on dual energy CT studies. Functional imaging techniques, mostly based on FDG PET-CT are in use, in particular for the assessment of early treatment response. Conclusions The impact and the limitations of PET-based therapy monitoring, as well as its comparison with CT, MRI and survival data are discussed in this review. CT is still the standard method for the evaluation of therapy response despite its several limitations. FDG PET-CT is helpful for the assessment of early therapy response; however, more prospective data are needed to define its role as well as the appropriate time intervals for therapy monitoring. A multiparametric evaluation based on changes in both morphological and functional data has to be assessed in further prospective studies.
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Affiliation(s)
- Antonia Dimitrakopoulou-Strauss
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Ulrich Ronellenfitsch
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Caixia Cheng
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Leyun Pan
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Christos Sachpekidis
- Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Thomas Henzler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Dolanmaz D, Esen A, Mihmanlı A, Işık K. Management of central giant cell granuloma of the jaws with intralesional steroid injection and review of the literature. Oral Maxillofac Surg 2016; 20:203-209. [PMID: 26481917 DOI: 10.1007/s10006-015-0530-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE We report the results of the intralesional steroid injections for the management of central giant cell granuloma (CGCG) of the jaws. METHODS Seven CGCGs were treated with intralesional injection of corticosteroids. To accomplish this, 3.5 mL of triamcinolone and 3.5 mL of 0.5 % marcaine with 1/200,000 epinephrine (total 7 mL) were mixed. An adequate amount of steroid was injected into different areas of the lesion. This procedure was repeated on a weekly basis for 6 weeks. RESULTS Clinical and radiological examination showed complete resolution and ossification of the lesions in four patients. Partial recovery was achieved in two patients. One patient did not respond to the treatment and underwent surgical curettage. CONCLUSIONS We suggest that intralesional steroid injection is safe and effective for the treatment of CGCG, especially in non-aggressive lesions.
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Affiliation(s)
- Doğan Dolanmaz
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Selçuk University, Konya, Turkey
| | - Alparslan Esen
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Necmettin Erbakan University, Ankara Cd. No:75/A, Konya, Turkey.
| | - Ahmet Mihmanlı
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Bezmialem University, Istanbul, Turkey
| | - Kubilay Işık
- Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Necmettin Erbakan University, Konya, Turkey
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Molecular testing in oncology: problems, pitfalls and progress. Lung Cancer 2014; 83:309-15. [PMID: 24472389 DOI: 10.1016/j.lungcan.2013.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 12/21/2013] [Indexed: 01/18/2023]
Abstract
Recent advances in the understanding of the molecular basis of cancer and the development of molecular diagnostics based on this knowledge have done much to progress the fields of oncology and pathology. Technological developments such as Next Generation Sequencing (NGS) and multiplex assays have made feasible the widespread adoption of molecular diagnostics for clinical use. While these developments and advances carry much promise, there are pitfalls to implementing this testing. Choosing appropriate biomarkers is a vital first step for clinical use and being able to understand the complex relationship between predictive and prognostic biomarkers is a crucial component of this. Testing for standard of care biomarkers is not straightforward, one must choose carefully between clinical trial assays, assays that analyse the same biological phenomenon or surrogate biomarkers. Sample heterogeneity and population specific difference is assays may skew results and must be controlled for at the assay design stage. At a technical level, NGS has the potential to revolutionise laboratory practice and approaches to cancer treatment. However, use of this technology requires careful planning and implementation if one is to avoid technical and ethical quagmires. Finally, with FDA regulation of companion diagnostics one may be limited to therapy specific assays.
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De Giorgi U. Value of pharmacokinetic studies for patients with gastrointestinal stromal tumors. Future Oncol 2013; 9:1675-7. [PMID: 23862700 DOI: 10.2217/fon.13.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ugo De Giorgi
- Department of Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio & la Cura dei Tumori (IRST), Via Piero Maroncelli 40, 47014 Meldola (FC), Italy.
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Vrekoussis T, Stathopoulos EN, De Giorgi U, Kafousi M, Pavlaki K, Kalogeraki A, Chrysos E, Fiorentini G, Zoras O. Modulation of Vascular Endothelium by Imatinib: A Study on the EA.hy 926 Endothelial Cell Line. J Chemother 2013; 18:56-65. [PMID: 16572895 DOI: 10.1179/joc.2006.18.1.56] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In this study the EA.hy 926 endothelial cell line--simulating endothelial cells--was treated with imatinib in order to define a possible anti-angiogenic role for imatinib. Dose and time response experiments were performed. Cell morphology was studied, while migration efficiency, intercellular permeability and VE-cadherin expression were assayed, both in the presence and in the absence of imatinib. Imatinib-induced EA.hy 926 cell apoptosis was also examined. Results showed that imatinib reduced the endothelial cell population, changed cell monolayer morphology and reduced cell-to-cell cohesiveness. Migration efficiency was significantly decreased while intercellular permeability was 2.76-fold increased in the presence of imatinib. Indirect immunofluorescence microscopy showed nearly complete down-regulation of VE cadherin in imatinib-treated cells. Furthermore, apoptotic activity was detected in imatinib-treated cells. Altogether our results support an antiangiogenic profile for imatinib that possibly contributes to its therapeutic potential.
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Affiliation(s)
- T Vrekoussis
- Department of General Surgery, University Hospital and Medical School, University of Crete, Greece
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15
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Si L, Xu X, Kong Y, Flaherty KT, Chi Z, Cui C, Sheng X, Li S, Dai J, Yu W, Guo J. Major Response to Everolimus in Melanoma With Acquired Imatinib Resistance. J Clin Oncol 2012; 30:e37-40. [PMID: 22162580 DOI: 10.1200/jco.2011.37.9644] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Lu Si
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiaowei Xu
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Yan Kong
- Peking University Cancer Hospital and Institute, Beijing, China
| | | | - Zhihong Chi
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Chuanliang Cui
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Xinan Sheng
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Siming Li
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Jie Dai
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Weiwei Yu
- Peking University Cancer Hospital and Institute, Beijing, China
| | - Jun Guo
- Peking University Cancer Hospital and Institute, Beijing, China
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Baykara M, Akkus M, Yildiz R, Gonul II, Dursun A, Coskun U, Benekli M, Sevinc A, Dane F, Buyukberber S. Survivin expression and its potential clinical significance in gastrointestinal stromal sarcoma. Int Immunopharmacol 2011; 11:2227-31. [PMID: 22020290 DOI: 10.1016/j.intimp.2011.10.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Revised: 10/02/2011] [Accepted: 10/03/2011] [Indexed: 11/29/2022]
Abstract
This study was designed to determine the level of survivin expression and its clinical significance as a prognostic factor in gastrointestinal stromal sarcoma (GIST). Twenty patients (12 males and 8 females) ranging in age from 25 to 72, with a median age of 53 were evaluated. Failure of TKI treatment was higher in the survivin-positive group (p=0.06). The rate of metastasis was significantly higher in the survivin positive group vs. the negative group (80% vs. 30%, p=0.18). The median overall survival (OS) time was 114 (range 29-199)months, and the median disease-free survival (DFS) time was 88 (range 40-135) months. The median progression-free survival (PFS) time was 40 (range 24-55) months. Further, a comparison of patients with survivin positive versus negative tumors, revealed no significant difference for OS, DFS, and PFS (p=0.45, p=0.19, p=0.55, respectively), number of mitoses in 50 HPF (p=0.14), and tumor size (p=0.94). In conclusion, survivin was highly expressed in GISTs, although we found no correlation between survivin expression and PFS, DFS and OS, survivin may be a predictive marker in GISTs for disease progression. We believe that additional studies are warranted to determine the clinical significance of survivin expression as a prognostic or predictive marker in patients with GIST.
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Affiliation(s)
- Meltem Baykara
- Gazi University Medical Faculty, Department Of Medical Oncology, Ankara, Turkey
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Abstract
Gastrointestinal stromal tumor (GIST) is a rare primary neoplasm of the gastrointestinal tract, mesentery, or omentum. In the past, surgery has been the only effective treatment. The diagnosis and treatment of GIST has been revolutionized over the past decade, since expression of the receptor tyrosine kinase KIT was shown to occur on these tumors. Mutations in this proto-oncogene commonly cause constitutive activation of the KIT tyrosine kinase receptor, an important factor in the pathogenesis of the disease. The development of specific tyrosine kinase inhibitors, such as imatinib mesylate, has led to a breakthrough in the treatment of advanced GIST. Treatment with this drug has led to significant improvements in survival, with overall response rates in excess of 80%. Side effects are common, but usually manageable. The success of this drug has led to further trials investigating its use in the pre- and postoperative situation. This review summarizes the current knowledge of GIST and imatinib treatment and possible future developments.
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Affiliation(s)
- Omar S Din
- Academic Department of Clinical Oncology, University of Sheffield Weston Park Hospital, Sheffield, UK
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18
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Papaetis GS, Syrigos KN. Targeted therapy for gastrointestinal stromal tumors: current status and future perspectives. Cancer Metastasis Rev 2010; 29:151-70. [PMID: 20112054 DOI: 10.1007/s10555-010-9206-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Gastrointestinal stromal tumors (GISTs) present 80% of gastrointestinal tract mesenchymal tumors, with systemic chemotherapy and radiotherapy being unable to improve survival of patients with advanced disease. The identification of activating mutations in either KIT cell surface growth factor receptor or platelet-derived growth factor receptor alpha, which lead to ligand-independent signal transduction, paved the way for the development of novel agents that selectively inhibit key molecular events in disease pathogenesis. The development of imatinib mesylate in the treatment of metastatic GIST represents a therapeutic breakthrough in molecularly targeted strategies, which crucially improved patients' prognosis while its usefulness in adjuvant and neoadjuvant setting is under study. Sunitinib malate is available in the second-line setting, with ongoing studies evaluating its role in an earlier disease stage, while other targets are under intense investigation in order to enrich the therapeutical armamentarium for this disease. GIST phenotype seems to be an essential indicator of treatment response; thus, obtaining genotype information of each patient may be critical in order to tailor individualized treatment strategies and achieve maximal therapeutic results.
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Affiliation(s)
- Georgios S Papaetis
- Oncology Unit, 3rd Department of Medicine, Athens School of Medicine, Sotiria General Hospital, Athens, Greece.
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19
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Ichikawa Y, Miyagi Y, Fujii S, Ota M, Yamagishi S, Hasegawa S, Saito S, Ike H, Ohki S, Nakano A, Matsumura N, Ishikawa T, Kunizaki C, Shimada H. Gastrointestinal stromal tumor with two genetic abnormalities on different alleles: report of a case. Surg Today 2010; 40:262-6. [PMID: 20180082 DOI: 10.1007/s00595-008-4029-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 07/03/2008] [Indexed: 11/29/2022]
Abstract
We report a case of a gastrointestinal stromal tumor (GIST) with strong and faint KIT protein staining, respectively, at two different sites. A single point mutation (c1727 T>C) was detected in DNA extracted from both sites, and a further deletion mutation (c1678_1680 del GTT) was detected in DNA from the site with strong KIT protein staining. Cloning analysis indicated that the point mutation and the deletion were present on different alleles.
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Affiliation(s)
- Yasushi Ichikawa
- Department of Gastroenterological Surgery, Yokohama City University Postgraduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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20
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Merkel cell carcinoma: lack of KIT positivity and implications for the use of imatinib mesylate. Appl Immunohistochem Mol Morphol 2009; 17:276-81. [PMID: 19276970 DOI: 10.1097/pai.0b013e318194da49] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The large variability (7% to 100%) in previously reported rates of receptor tyrosine kinase KIT expression in Merkel cell carcinoma (MCC) may be owing to the use of heat-induced epitope retrieval. High frequency of reported KIT reactivity by immunohistochemistry (IHC) in part prompted the initiation of a phase 2 clinical trial of imatinib mesylate (Gleevec, Novartis Pharmaceuticals, East Hanover, NJ) for the treatment of advanced MCC. Our experience has been that a small number of MCCs (12.5%) are positive for KIT by IHC. We also found a higher rate of apparently KIT-positive MCCs (75%) using heat-induced epitope retrieval. Our anecdotal experience with the use of imatinib mesylate has been disappointing. As IHC detection of KIT expression does not correlate with the presence of KIT-activating mutations, protein expression as tested by IHC should not be used to determine if patients would respond to imatinib mesylate. Indeed, our review of the literature and the apparent lack of efficacy of imatinib mesylate for MCC in a recent phase 2 trial suggest a minor role for KIT signaling in MCC tumorigenesis.
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21
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Blay JY. New paradigms in gastrointestinal stromal tumour management. Ann Oncol 2009; 20 Suppl 1:i18-24. [DOI: 10.1093/annonc/mdp075] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Surgical outcomes of patients with gastrointestinal stromal tumors in the era of targeted drug therapy. J Gastrointest Surg 2008; 12:2023-31. [PMID: 18546049 DOI: 10.1007/s11605-008-0561-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2008] [Accepted: 05/02/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND The discovery of the c-KIT mutation and the advent of targeted drug therapy with imatinib mesylate have revolutionized the management of gastrointestinal stromal tumors (GISTs). The outcome of patients with surgically treated GISTs treated in the era of targeted drug therapy was assessed and factors associated with adverse outcomes determined. MATERIALS AND METHODS Patients with GISTs requiring surgery at a tertiary care center from 2002 to 2007 were reviewed and prognostic factors determined. RESULTS Forty patients were surgically treated for GISTs. The median age at presentation was 59 years. The stomach (55%) was the main site of primary disease. The median tumor size was 7 cm. Eleven (28%) patients had metastatic disease at presentation. Surgery was undertaken in all patients with curative intent. Multi-organ resection was required in 10 (25%) patients. Imatinib mesylate was administered postoperatively in 68% of cases. Median follow-up was 24 months. There was a 40% recurrence rate with 63% undergoing repeat surgical resection. The peritoneum and liver were the main sites of recurrent disease. The 5-year disease-specific survival and disease-free survival (DFS) were 65% and 35%, respectively. High mitotic rate (P = 0.017) and tumor size greater than 10 cm (P = 0.009) were the only prognostically significant adverse factors of DFS on multivariate analysis, independent of imatinib mesylate treatment. CONCLUSION Aggressive surgical treatment and follow-up of GISTs, combined with targeted drug therapy, leads to long-term DFS survival. Tumor recurrence is independently associated with a high tumor mitotic rate and size greater than 10 cm, despite the use of adjuvant targeted drug therapy.
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23
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Duffy MJ. Role of tumor markers in patients with solid cancers: A critical review. Eur J Intern Med 2007; 18:175-84. [PMID: 17449388 DOI: 10.1016/j.ejim.2006.12.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2005] [Revised: 11/03/2006] [Accepted: 12/15/2006] [Indexed: 01/26/2023]
Abstract
The measurement of tumor markers is currently one of the most rapidly growing areas in laboratory medicine. Lack of sensitivity and specificity preclude the use of most existing markers for the early detection of malignancy. For patients with diagnosed malignancy, however, markers are potentially useful in determining prognosis, predicting therapeutic response, maintaining surveillance following curative surgery and monitoring therapy in advanced disease. Clinically useful markers include CEA in the surveillance of patients with diagnosed colorectal cancer, AFP and HCG in the management of patients with non-seminomatous germ cell tumors, HCG in the management of patients with trophoblastic disease, CA 125 for monitoring therapy in patients with ovarian cancer, estrogen receptors for predicting response to hormone therapy in breast cancer and HER-2 for the identification of women with breast cancer likely to respond to trastuzumab (Herceptin). Although widely used, the impact of PSA screening in reducing mortality from prostate cancer remains to be shown.
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Affiliation(s)
- Michael J Duffy
- Department of Pathology and Laboratory Medicine, St Vincent's University Hospital, Dublin 4, UCD School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical Research, University College Dublin and Dublin Molecular Medicine Institute, Dublin 4, Ireland
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24
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Blay JY, Le Cesne A, Ray-Coquard I, Bui B, Duffaud F, Delbaldo C, Adenis A, Viens P, Rios M, Bompas E, Cupissol D, Guillemet C, Kerbrat P, Fayette J, Chabaud S, Berthaud P, Perol D. Prospective multicentric randomized phase III study of imatinib in patients with advanced gastrointestinal stromal tumors comparing interruption versus continuation of treatment beyond 1 year: the French Sarcoma Group. J Clin Oncol 2007; 25:1107-13. [PMID: 17369574 DOI: 10.1200/jco.2006.09.0183] [Citation(s) in RCA: 307] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Imatinib is the standard treatment of advanced GI stromal tumors (GISTs). It is not known whether imatinib may be stopped in patients in whom disease is controlled. METHODS This prospective, randomized, multicentric phase III study was designed to compare continuous (CONT) compared with interrupted (INT) imatinib beyond 1 year of treatment in patients with advanced GIST. The primary end point was progression-free survival. Secondary end points included overall survival, response rate after reinitiation of imatinib, and quality of life. Early stopping rules in cases of rapid progression of disease were defined, with preplanned interim analyses. RESULTS Between May 2002 and April 2004, 182 patients with advanced GIST were enrolled. Between May 2003 and April 2004, 98 patients in response or stable disease under imatinib reached more than 1 year of follow-up. Forty were not eligible for randomization, and 58 patients were randomly assigned, 32 and 26 patients in the INT and CONT arms, respectively. As of October 15, 2005, eight of 26 patients in the CONT group and 26 of 32 patients in the INT group had documented disease progression (P < .0001). Twenty-four of 26 patients with documented progression in the INT arm responded to imatinib reintroduction. No differences in overall survival or imatinib resistance were observed between the two arms. Quality of life evaluated 6 months after random assignment using the 30-item Quality of Life Questionnaire was not significantly different between the two groups of randomly assigned patients. CONCLUSION Imatinib interruption results in rapid progression in most patients with advanced GIST, and cannot be recommended in routine practice unless patient experience significant toxicity
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Affiliation(s)
- Jean-Yves Blay
- Unité INSERM U590 Centre Léon Bérard & Université Claude Bernard Lyon I & Hopital Edouard Herriot, Lyon, France.
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25
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De Giorgi U. KIT Mutations and Imatinib Dose Effects in Patients With Gastrointestinal Stromal Tumors. J Clin Oncol 2007; 25:1146-7; author reply 1147-8. [PMID: 17369583 DOI: 10.1200/jco.2006.09.5331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Nagase S, Mikami Y, Moriya T, Niikura H, Yoshinaga K, Takano T, Ito K, Akahira J, Sasano H, Yaegashi N. Vaginal tumors with histologic and immunocytochemical feature of gastrointestinal stromal tumor: two cases and review of the literature. Int J Gynecol Cancer 2007; 17:928-33. [PMID: 17359292 DOI: 10.1111/j.1525-1438.2007.00892.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract (GI). Although positive immunohistochemistry for c-kit protein (CD117) and CD34 is critical in establishing diagnosis, the clinicopathologic features of CD117-positive mesenchymal tumors without obvious connection to the GI tract are not well documented. We describe the clinicopathologic features of two cases of extra-GIST. Case 1 was a 42-year-old woman who presented with a submucosal tumor located in the posterior vaginal wall. Case 2 was a 66-year-old woman who presented with a mass that bulged from the right side of the middle vaginal wall. Both tumors were excised locally. The results of microscopic examination and immunohistochemistry for both cases indicated the diagnosis of GIST. Case 2, in addition, showed oncogenic mutation in KIT exon 11. Case 1 is healthy without evidence of recurrence 4 years after surgery. Case 2 started imatinib therapy after resection of a recurrent mass. Gynecologists as well as diagnostic pathologists should be aware of GIST manifesting as a vaginal mass. Recognition of microscopic patterns and characteristic immunohistochemical phenotype, plus genetic study, is mandatory for establishing the correct diagnosis of GIST.
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Affiliation(s)
- S Nagase
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan.
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27
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Raut CP, Morgan JA, Ashley SW. Current issues in gastrointestinal stromal tumors: incidence, molecular biology, and contemporary treatment of localized and advanced disease. Curr Opin Gastroenterol 2007; 23:149-58. [PMID: 17268243 DOI: 10.1097/mog.0b013e32802086d0] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Few areas in oncology have witnessed the major paradigm shift that has been noted in the understanding and management of gastrointestinal stromal tumors. This review highlights the progress made over the last 2 years. RECENT FINDINGS Population-based studies have provided insight into the true incidence of gastrointestinal stromal tumors. Improved understanding of the molecular biology has provided prognostic implications and may guide treatment in the future. More mature follow-up data from phase III trials have proven that the targeted tyrosine kinase inhibitor imatinib mesylate is a dramatically effective agent, but the duration of its benefits are finite, and drug resistance is an increasingly more common phenomenon. Adjuvant and neoadjuvant trials of imatinib are currently underway. A second targeted tyrosine kinase inhibitor, sunitinib malate, has been approved for the treatment of imatinib-resistant gastrointestinal stromal tumors after recent encouraging results. Finally, the success with imatinib and sunitinib has encouraged investigators to reevaluate the role of surgery in advanced gastrointestinal stromal tumors. SUMMARY The multidisciplinary management of gastrointestinal stromal tumors serves as a model of how new targeted molecular therapies can be combined with traditional treatment modalities to improve survival in advanced malignancies.
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Affiliation(s)
- Chandrajit P Raut
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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28
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Yang Y, Ikezoe T, Nishioka C, Taguchi T, Zhu WG, Koeffler HP, Taguchi H. ZD6474 induces growth arrest and apoptosis of GIST-T1 cells, which is enhanced by concomitant use of sunitinib. Cancer Sci 2006; 97:1404-9. [PMID: 16995874 PMCID: PMC11159663 DOI: 10.1111/j.1349-7006.2006.00325.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ZD6474 (Zactima, AstraZeneca, Macclesfield, UK) is an orally available, small-molecule inhibitor of vascular endothelial growth factor receptor-2 and epidermal growth factor receptor tyrosine kinases, with additional activity versus rearranged during transfection (RET). This study explored the effect of ZD6474 in gastrointestinal stromal tumor-T1 (GIST-T1) cells that possess a gain of function mutation in exon 11 of the c-KIT gene. ZD6474 induced growth arrest and apoptosis of GIST-T1 cells in association with blockade of c-Kit and its downstream effectors, including Akt and extracellular signal-regulated kinase (ERK). ZD6474 treatment also blocked the mammalian target of rapamycin (mTOR), which lies downstream of Akt and ERK. Interestingly, when ZD6474 was combined with sunitinib (SU11248; Sutent, Pfizer, Kalamazoo, MI, USA), a class III and V receptor tyrosine kinase inhibitor, the ZD6474-mediated growth inhibition was potentiated in association with further down-regulation of the mTOR targets p-p70S6K and p-4E-BP-1. The combination of ZD6474 and sunitinib should be investigated further.
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Affiliation(s)
- Yang Yang
- Department of Biochemistry and Molecular Biology, Peking University Health Science Center, Beijing 100083, China
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29
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Shinomura Y. [Etiology of and therapy for gastrointestinal stromal tumor]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2006; 95:1939-45. [PMID: 17037339 DOI: 10.2169/naika.95.1939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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30
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Ikezoe T, Yang Y, Nishioka C, Bandobashi K, Nakatani H, Taguchi T, Koeffler HP, Taguchi H. Effect of SU11248 on gastrointestinal stromal tumor-T1 cells: enhancement of growth inhibition via inhibition of 3-kinase/Akt/mammalian target of rapamycin signaling. Cancer Sci 2006; 97:945-51. [PMID: 16916320 PMCID: PMC11159839 DOI: 10.1111/j.1349-7006.2006.00263.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
SU11248 is an orally available type III and V receptor tyrosine kinase inhibitor. Clinical studies have shown the efficacy of SU11248 in individuals with gastrointestinal stromal tumors (GIST); however, the molecular mechanisms by which SU11248 inhibits the proliferation of these tumor cells remains to be fully elucidated. Taking advantage of GIST-T1 cells, which possess an activating mutation in exon 11 of the c-KIT gene, we examined the medicinal action of SU11248 in GIST cells. Clonogenic and MTT assays showed that SU11248 potently inhibited the proliferation of GIST-T1 cells with IC50 of approximately 1 nM and 40 nM, respectively. SU11248 (10 or 20 nM, 48 h) activated caspase-3 and induced apoptosis of GIST-T1 cells as measured by caspase assay, annexin V staining and cleavage of poly (ADP-ribose) polymerase. Western blot analyses found that SU11248 blocked autophosphorylation of c-KIT in association with inhibition of its downstream effectors, including Akt and extracellular signal-regulated kinase, but not signal transducers and activators of transcription. Interestingly, when phosphatidylinositol 3-kinase/Akt/mammalian target of rapamycin signaling was blocked simultaneously by either LY294002 or rapamycin, growth inhibition mediated by SU11248 was potentiated. Taken together, this study supports clinical studies of SU11248 for individuals with GIST, and the combination of SU11248 and inhibitors of 3-kinase/Akt/mammalian target of rapamycin signaling represents a promising novel treatment strategy.
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Affiliation(s)
- Takayuki Ikezoe
- Department of Hematology and Respiratory Medicine, Graduate School of Kuroshio Science, Kochi University, Nankoku, Kochi 783-8505, Japan.
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31
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Oh JS, Lee JL, Kim MJ, Ryu MH, Chang HM, Kim TW, Jang SJ, Yook JH, Oh ST, Kim BS, Kang YK. Neoadjuvant imatinib in locally advanced gastrointestinal stromal tumors of the stomach: report of three cases. Cancer Res Treat 2006; 38:178-83. [PMID: 19771279 DOI: 10.4143/crt.2006.38.3.178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Accepted: 08/30/2006] [Indexed: 01/08/2023] Open
Abstract
Neoadjuvant imatinib therapy used to treat locally advanced or metastatic gastrointestinal stromal tumors (GI ST) remains under active investigation. We studied three cases of locally advanced gastric GISTs treated with imatinib on a neoadjuvant basis, followed by a complete surgical resection. Three patients were diagnosed with locally advanced unresectable GIST of the stomach and were started on imatinib 400 mg/day. After the imatinib treatment, partial responses were achieved in all patients and the tumors were considered resectable. Surgical resection was done after 7, 11, and 8 months of imatinib therapy, respectively. In one case, a metastatic liver lesion was detected during the imatinib treatment using computed tomography scans, so the imatinib therapy was maintained for 11 months postoperatively. In the other two patients without distant metastasis, imatinib treatment was not restarted after surgery. Mutational analysis revealed a mutation in exon 11 of the c-kit gene in two patients, and wild-type c-kit and PDGFRA in one patient. During pathology review of all three cases, we noted several features common to imatinib treatment. There was no evidence of tumor recurrence in all three patients at respective follow-up visits of 22, 15, and 7 months. These results suggest that the neoadjuvant imatinib therapy is a potentially curative approach for selected patients with locally advanced GIST.
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Affiliation(s)
- Ji Seon Oh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Foster R, Solano S, Mahoney J, Fuller A, Oliva E, Seiden MV. Reclassification of a tubal leiomyosarcoma as an eGIST by molecular evaluation of c-KIT. Gynecol Oncol 2006; 101:363-6. [PMID: 16439005 DOI: 10.1016/j.ygyno.2005.12.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Revised: 12/05/2005] [Accepted: 12/07/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Extragastrointestinal stromal tumors (eGISTs) are rare mesenchymal-derived tumors arising outside of the GI tract. eGISTs are often histologically confused with leiomyosarcoma. Distinction between eGIST and leiomyosarcoma is critical because of the unique responsiveness of eGISTs to the molecularly targeted agent imatinib. CASE A woman presented with a history of tubal spindle cell tumor that was initially diagnosed and treated as a leiomyosarcoma. Because of minimal response to sarcoma directed chemotherapy, the possibility that the tumor was in fact an eGIST was investigated and supported by immunohistochemical and mutational analyses of the c-Kit receptor tyrosine kinase. The patient currently has stable disease control on imatinib for the last 18 months. CONCLUSIONS The possibility of eGIST should be considered in the differential diagnosis of tumors with a spindle cell morphology in the gynecologic tract especially when involving the ovary, fallopian tube, or uterine serosa.
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Affiliation(s)
- Rosemary Foster
- Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA 02114, USA.
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De Giorgi U, Aliberti C, Benea G, Conti M, Marangolo M. Effect of Angiosonography to Monitor Response During Imatinib Treatment in Patients with Metastatic Gastrointestinal Stromal Tumors. Clin Cancer Res 2005; 11:6171-6. [PMID: 16144917 DOI: 10.1158/1078-0432.ccr-04-2046] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Gastrointestinal stromal tumor (GIST) metastases are typically intra-abdominal and hypervascular. We assessed the effect of angiosonography with a second-generation contrast agent to monitor response during imatinib treatment in patients with metastatic KIT+ GIST. EXPERIMENTAL DESIGN Ten consecutive patients with known advanced KIT+ GIST were investigated with angiosonography and computerized tomography (CT). We also monitored the serum levels of the major angiogenic growth factor, vascular endothelial growth factor. RESULTS Angiosonography showed a reduction in tumor vascularization of liver metastases during imatinib treatment in all cases. We observed a reduction in tumor vascularization before a reduction in tumor size. The tumor perfusion appeared reduced in the central part of the liver metastases. With a median follow-up of 18 months (range 3-33), a reduction in tumor vascularization was initially observed in all patients, but progressive disease was documented in four patients following imatinib treatment. CT documented tumor response according to standardized criteria in six patients, stable disease in four, and progressive disease according to angiosonography. The reduction of tumor perfusion at angiosonography correlated with the pseudocystic appearance at CT. The "nodule(s) within a mass" pattern of recurrence occurred in two patients with no difference observed between angiosonography and CT. Early decreasing serum vascular endothelial growth factor levels were observed in the two cases with higher pretreatment levels. CONCLUSIONS Imatinib could induce antiangiogenic and/or antivascular effects in GIST, and this effect could be easily monitored with angiosonography. Angiosonography might be a useful complement for monitoring the therapeutic effect of imatinib in these patients.
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Affiliation(s)
- Ugo De Giorgi
- Istituto Oncologico Romagnolo, Department of Oncology, Santa Maria delle Croci Hospital, Ravenna, Italy.
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Shinomura Y, Kinoshita K, Tsutsui S, Hirota S. Pathophysiology, diagnosis, and treatment of gastrointestinal stromal tumors. J Gastroenterol 2005; 40:775-80. [PMID: 16143881 DOI: 10.1007/s00535-005-1674-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Accepted: 07/01/2005] [Indexed: 02/04/2023]
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Activating mutations of KIT or the platelet-derived growth factor receptor alpha gene (PDGFRA) have been identified in the vast majority of GISTs. The respective oncoproteins exhibit constitutive tyrosine kinase activity and promote cell growth. KIT and PDGFRA mutations are rarely found in GISTs in patients with neurofibromatosis type 1 (NF1) suggesting that the pathogenesis of GIST in NF1 patients is different from that in non-NF1 patients. Endoscopic diagnosis of GIST is usually difficult. Endoscopic ultrasonography (EUS)-guided fine-needle aspiration biopsy (EUS-FNAB) is a useful method for the diagnosis of GIST and for the detection of KIT or PDGFRA mutations. Imatinib mesylate, a tyrosine kinase inhibitor known to inhibit the activities of BCR-ABL, KIT, and PDGFR, is currently being used for the treatment of both chronic myeloid leukemia and metastatic GIST. The clinical response to imatinib therapy correlates with the types of mutations of KIT and PDGFRA, and the determination of KIT and PDGFRA mutations is useful for predicting the effect of imatinib. Resistance to imatinib after an initial response has been reported; secondary point mutations in KIT or PDGFRA that confer imatinib resistance are the most common mechanisms responsible for acquired resistance to imatinib. The continued development of target-specific therapies should increase the probability of cure in most patients with GISTs.
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Affiliation(s)
- Yasuhisa Shinomura
- First Department of Internal Medicine, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, 060-8543, Japan
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