2 consequences In localizedsettingwe can take advantagesofitsactivity, but: Do not miss the best time point to operate Imatinib does not work infinitely The patient might get biased towards continuing medical treatment instead of operative treatment Neoadjuvant therapy and efficacy might otherwise have been in vain
2 consequences In localizedsettingwe can take advantagesofitsactivitytolimit the extentofsurgery In metastaticsetting, couldweprolongitsefficacy ?
b. Front-lineSurgeryDoesNotImprove PFS in Metastatic GIST in Imatinib Era R2/No surgery before IM onset Surgical complete remission before IM onset 54 pts 99 pts Bui B et al. Do patients with initially resected metastatic GIST benefit from 'adjuvant' imatinib (IM) treatment? Results of the prospective BFR14 French Sarcoma Group randomized phase III trial. ASCO Annual Meeting 2006. Abstract 9501
c.Response to Imatinib Correlates with Surgical Result
d. Imatinib interruption is detrimental even after surgical complete remission
Wesimply don’t knowtowhichextentsurgeryprolong the durationof IM activity in respondingpatients
the ideal way togetananswer Imatinib FollowforPFS & OS Metastatic GIST in response on IM Imatinib + surgery at best response (within 1 yr)
Allocation by pt. will Imatinib FollowforPFS & OS Metastatic GIST in response on IM Imatinib + surgery at best response Providingadequateinformedconsentisgiven and eligibilitycriteria are met Benjamin et al. Proc Am Soc Clin Oncol. 2003;22:814. Abstract 3271. Rankin et al. Proc Am Soc Clin Oncol. 2004;23:815. Abstract 9005. Verweij et al. Proc Am Soc Clin Oncol. 2003;22:814. Abstract 3272.
Surgeryfor rare tumorshasforcedto Describecriteriaforsurgicaladequacy Set up prospective data basestounderstandnaturalhistory and underlyingbiologyotherwisestillobscureof rare diseases Foster collaborationbetweendifferentdisciplines in localized and metastaticsettings Deal withnew target therapies in solidtumors and help establishingnewparadigms