I would like to thank Max Foundation for this wonderful initiative of regular GIST Meets. Thanks to Viji Venkatesh & her team for organizing it so well.
During one such meet at Conclave, December 2013 in Tata Hospital, I was introduced to Markus Wartenberg, Director of European Sarcoma Association, following which I was invited by him to represent Friends Of Max India at New Horizons GIST Meet in Zurich to be held in May 14-17 2014.
The Motto of the meet was Improving Access to Treatment and Quality of Care through Global Exchange.
It is an Annual meet where Top Oncologists & GIST Surgeons meet along with various members of GIST Support Groups/Organizations around the World for Knowledge exchange & updating on latest Treatment modalities for GIST.
This is important as Treatment of GIST is just 14 years old & is constantly evolving.
Amongst the notable speakers were Dr. Heikki from Finland, who is the first Doctor to start treatment for GIST using Glivec! Dr. Reichardt & Dr. Bauer were amongst the many excellent Speakers present at the meet.
Being a GIST only meet, a very intensive discussion about GIST from Cellular Pathology level to Importance of Mutational Testing was emphasized.
Genotyping helps in GIST Diagnosis, Prognosis, identifying primary resistance, dose selection. It is recommended by ESMO & NCCN guidelines.
A talk on common occurrence of MicroGist in healthy population was mentioned & possibility of it turning into MacroGist was linked due to increase in Gastrin production, i.e., hyperacidity .Emphasis was laid on the need to keep our Body ph Alkaline for which we need to have a change of Lifestyle.
Glivec as a drug causes cell death of GIST cells but sometimes it just suppresses cell growth & may not kill all GIST cells. Therefore it is Important to
1. 1.Take daily dose of Glivec, a single dose missed can cause mutation.
2. 2.To take the drug for a longer period of Time, in some cases of Metastatic GIST it should be taken Lifelong.
One should consult his/her Oncologist/Surgeon about their individual case & Duration of Adjuvant therapy.
Neo-Adjuvant Therapy causes shrinkage of tumour size thereby effecting a lesser invasive Surgery & lesser Peropeartive risk of bleeding & Tumour Rupture.
It also helps in Organ preservation.
Best response is upto 7 months of starting the drug & lesser response is seen after 9 months. Therefore the ideal time to operate & remove the tumour is between 6-12 months of starting Neo-Adjuvant Glivec.
Surgery is the final curative treatment for GIST.
Adjuvant Glivec post-Surgery should be given according to each individual case which may extend upto lifelong for patients with initial Metastatic disease. Consult your Oncologist for your specific case.
Estimating Risk of recurrence depends on Tumour Size, Tumour Site, Mitotic count & Tumour rupture.
It is Important to have regular follow-up with your doctor including doing Blood test, CT(3phase CT scan)/MRI imaging etc.
Recent Developments in treatment of Gist:
1. Individual dosing of the drug should be done according to Patients Age, Weight, General status, Dietary status etc. Random prescribing of drugs should be avoided for e.g. if a patient cannot tolerate 800 mg Glivec, then give 500 or 600mg. Or if Patient cannot tolerate 50 mg Sunitinib then give 25 mg or as according to chart.
Individualizing dosage will lead to better Tolerance of drug with fewer side effects & hence Better Patient Compliance & Better Quality of Life for the patient.
2. Rapid Alternation between drugs helps in overcoming resistance in Resistant GIST, e.g. 1month of Imatinib followed by Next month of Regorafenib which continues in a cycle, closely monitoring the patients response (Dr Heikki).
3. Newer drugs Like Masitinib / Pazopanib/ Ponatinib/ Crenolanib are being used in trials worldwide for Resistant GIST with good responses in some cases.
4. Radiofrequency Ablation /Chemo-Embolisation/Selective Artery Embolisation are also used in treatment of GIST.
5. Immunotherapy is also being explored as treatment for GIST, this targets the Kit structure outside the cell,where by you do not have to worry about Mutation status of Kit inside the cell on which Imatinib & other drugs act.
6. Liquid Biopsy is being used to study Circulating GIST DNA in blood sample, where by you can diagnose GIST & also use it for Mutational analysis & to start specific drug therapy. This method is still in its Infancy & is being bettered to use it as a tool for diagnosing GIST through a Blood sample.
7. Radiation therapy is being used for treatment of Metastatic GIST in Bone & Brain.
Radiation therapy is known to reduce the tumour & encapsulate it preventing its further spread. This is an interesting fact considering previously we knew GIST as Chemo & Radioresistant.
GIST is mostly treated Successfully with Imatinib & Surgery ,however some Resistant forms of GIST can also be treated successfully by Newer Drugs & Dosage regimes .
With Newer Drug Trials happening Around the World here is Hope for treating Even Resistant GIST.
Early & Prompt Diagnosis & Treatment from a GIST Expert & Adherence to Compliance by the Patient can Result in a Successful Treatment Outcome !
Report by Dr Nikhil Guhagarkar