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Miami Report 2015

New Horizons GIST 2015 was held in Miami from 15-17th May 2015. The aim of the meet is to improve Global understanding of GIST ,its treatment  and Advocacy.

I was fortunate to be part of the group of people across the world from various organizations. There were 2 parts of the meet:
1st Part was Clinical Presentations and 2nd Part was Advocacy and Group building.

Amongst the Doctors attending the meet were Dr Reichardt , Dr Matia, Dr Trent, Dr Livingstone, Dr Pablo.

The key points of the meets were as follows:

  • GIST is a rare cancer.
  • Imatinib is termed as the Magic Bullet and the first choice for most of cases of GIST.
  • Mutational analysis revealed  67% were KIT  ,12 % were PDGFRA  and 21 % were Wild type.

4  Aspects to GIST treatment

  1. Clinical and Pathological diagnosis
  2. Molecular testing
  3. Surgical treatment
  4. Systemic treatment

Surgeon is the most important supported by Oncologist and Clinician.

Aims of Surgery :

  • Complete Resection
  • Negative margins
  • Explore peritoneal cavity
  • Non mutilated surgery
  • Non tumour rupture
  • No routine Lymphadenectomy
Important Pathological Information :
  • T cms (size)
  • IM (N/50 HPF)Mitosis
  • C-Kit
  • Mutational Analysis
miami2Prognostic Classification :
Size + Mitosis + Site + Rupture + Mutation
Neo Adjuvant Therapy
Helps patients with potentially morbid surgery
  • Organ Preservation
  • Minimal invasive surgery
  • Reduces mortality and morbidity
Adjuvant Therapy :

Objective :
– To cure
– To delay recurrence
– To decrease Local /Sytemic  recurrence
– Benefits immediate and high risk patients  and may continue lifelong in patients with initial    Metastatic disease

Imatinib In GIST :

1st Line is Imatinib
85% Disease control

Scenario in Clinical Resistance to Imatinib :
  • False :Image interpretation –Radiology
  • False : Lack Of Adherence to taking the drug
  • False : Low dose –Exon 9 Mutation
  • True : Imatinib resistant mutation
  • True : Other Kinase activation

miami3miami4Drug Therapy in GIST

2nd Line Drug : Sunitinib
3rd Line Drug : Regorafenib


Multidisciplinary Team Approach for GIST
:
  • Pathologist
  • Oncologist
  • Gastroenterologist
  • Clinician/Researcher
  • Surgeon
  • Imagenologist
  • Radiotherapist
  • Genetic Expert
Newer Treatment Modalities:
  • Hepatic Artery Embolization
  • RFA
  • SIRT  (Selective Internal Radiation Therapy)
  • Immunotherapy  trials beginning in Miami ,Immunotherapy helps in removing protective cover on the cancer and attacks Cancer cells directly.
Axitinib +Pembrolizumab Immunotherapy
  • Combination Therapy
  • Additional drugs to cause cell death of GIST along with Imatinib by mechanism of Apoptosis (Drug ABT 737)
  • Autophagy( Drug Antimalarial Primaquine)
  • Radiation Therapy (Oesophageal + Rectal)  Bone metastasis
  • Individual  treatment.
miami1Key Points

Challenges : may present as an acute abdominal bleeding resulting in emergency surgery –Surgeon has to be well informed of operating on such cases.

  • Drug Holiday not recommended
  • Have GIST speciality centre

 

 


Report by Dr. Nikhil Guhagarkar- FOM Mumbai

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