Neoadjuvant Imatinib, Surgery and Neoadjuvant Imatinib, Surgery and then ? then ? Seattle Seattle 2007 2007 Neoadjuvant Imatinib, Surgery and then ? Department of Surgery Department of Surgery 1 and Medical Oncology and Medical Oncology 2 Netherlands Cancer Institute Netherlands Cancer Institute - - Antoni van Antoni van Leeuwenhoek ziekenhuis Leeuwenhoek ziekenhuis Amsterdam The Amsterdam The Netherlands Netherlands Frits van Coevorden Frits van Coevorden 1 , Koert , Koert Kuhlmann Kuhlmann 1 , , J.Martijn Kerst J.Martijn Kerst 2 and Annemieke Cats and Annemieke Cats 2
Neoadjuvant Imatinib, Surgery and then ?. Frits van Coevorden 1 , Koert Kuhlmann 1 , J.Martijn Kerst 2 and Annemieke Cats 2. Department of Surgery 1 and Medical Oncology 2 Netherlands Cancer Institute - Antoni van Leeuwenhoek ziekenhuis Amsterdam The Netherlands. - PowerPoint PPT Presentation
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Neoadjuvant Imatinib, Surgery and then ?Neoadjuvant Imatinib, Surgery and then ?
Seattle Seattle 20072007
Neoadjuvant Imatinib, Surgery and then ?
Department of SurgeryDepartment of Surgery11 and Medical Oncology and Medical Oncology22
Netherlands Cancer InstituteNetherlands Cancer Institute - - Antoni van Leeuwenhoek ziekenhuisAntoni van Leeuwenhoek ziekenhuis Amsterdam The NetherlandsAmsterdam The Netherlands
Frits van CoevordenFrits van Coevorden11, Koert Kuhlmann, Koert Kuhlmann11 , ,
J.Martijn KerstJ.Martijn Kerst22 and Annemieke Catsand Annemieke Cats22
Neoadjuvant Imatinib, Surgery and then ?Neoadjuvant Imatinib, Surgery and then ?
Seattle Seattle 20072007
•Imatinib has a well established role in metastatic GISTImatinib has a well established role in metastatic GIST
•Studies on Adjuvant Imatinib after surgery are ongoingStudies on Adjuvant Imatinib after surgery are ongoing
Neoadjuvant Imatinib, Surgery and then ?Neoadjuvant Imatinib, Surgery and then ?
Seattle Seattle 20072007
• Imatinib has a well established role in metastatic GISTImatinib has a well established role in metastatic GIST
• Studies on Adjuvant Imatinib after surgery are ongoingStudies on Adjuvant Imatinib after surgery are ongoing
• the role of surgery after initial treatment with Imatinib the role of surgery after initial treatment with Imatinib for locally advanced or metastatic GIST is evolvingfor locally advanced or metastatic GIST is evolving
Neoadjuvant Imatinib, Surgery and then ?Neoadjuvant Imatinib, Surgery and then ?
Seattle Seattle 20072007
Surgical strategy in metastatic GISTSurgical strategy in metastatic GIST
•(unclear) Involvement of surrounding organs(unclear) Involvement of surrounding organs
•Primary resection expected to be a R1 resectionPrimary resection expected to be a R1 resection
•Primary resectable but also very restricted metastatic disease ?Primary resectable but also very restricted metastatic disease ?
Neoadjuvant Imatinib, Surgery and then ?Neoadjuvant Imatinib, Surgery and then ?
Seattle Seattle 20072007
Several papers have dealt with Several papers have dealt with
the role of surgerythe role of surgery
after initial treatment with Imatinib after initial treatment with Imatinib
. . Raut et al 2006Raut et al 2006
. Rutkowski et al 2006. Rutkowski et al 2006
. Bonvalot et al 2006. Bonvalot et al 2006
. Gronchi et al 2007. Gronchi et al 2007
. DeMatteo et al 2007. DeMatteo et al 2007
Neoadjuvant Imatinib, Surgery and then ?Neoadjuvant Imatinib, Surgery and then ?
Seattle Seattle 20072007
Progression free and Overall survivalProgression free and Overall survival after surgery after surgery after initial treatment with Imatinib for locally advanced or metastatic GISTafter initial treatment with Imatinib for locally advanced or metastatic GIST
Neoadjuvant Imatinib, Surgery and then ?Neoadjuvant Imatinib, Surgery and then ?
Seattle Seattle 20072007
PFS PFS andand OS OS after surgery after surgery after initial treatment with Imatinib for locally advanced or metastatic GISTafter initial treatment with Imatinib for locally advanced or metastatic GIST
Gronchi et al. Ann Surg 2007 DeMatteo Ann Surg 2007
Responding patients
Progressive patients
11,,0000,,8800,,6600,,4400,,22
00
pro
bab
ilit
yp
roba
bil
ity
Time Time (mo)(mo)
1100
4400
2200
5500
3300
6600
PFSPFS
OSOSPFSPFS
Neoadjuvant Imatinib, Surgery and then ?Neoadjuvant Imatinib, Surgery and then ?
Seattle Seattle 20072007
Locally advanced GIST stomach: start Imatinib feb 2006Result after 8 months
Case history Neoadjuvant Imatinib, 60 yr femaleCase history Neoadjuvant Imatinib, 60 yr female
Neoadjuvant Imatinib, Surgery and then ?Neoadjuvant Imatinib, Surgery and then ?
Seattle Seattle 20072007
Partial gastrectomyPartial gastrectomy
(greater curvature)(greater curvature)
Surgery 8 months after start Imatinib
R0 resection
Neoadjuvant Imatinib, Surgery and then ?Neoadjuvant Imatinib, Surgery and then ?
Seattle Seattle 20072007
Neoadjuvant Imatinib, Surgery and then ?Neoadjuvant Imatinib, Surgery and then ?
What is the role of Imatinib after resection ?What is the role of Imatinib after resection ?
Nobody knows or at least unclearNobody knows or at least unclear