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
- Clinical and Pathological diagnosis
- Molecular testing
- Surgical treatment
- 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
Prognostic 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
Drug Therapy in GIST
Drug Therapy in GIST2nd 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.
Key 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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