Z Gastroenterol 2015; 53(03): 235-243
DOI: 10.1055/s-0034-1385711
Kongressbericht
© Georg Thieme Verlag KG Stuttgart · New York

Gastrointestinale Stromatumoren (GIST) – Neues zu Pathologie, Chirurgie und medikamentöser Therapie

Erarbeitet im Rahmen des 10. Deutschen GIST-Treffens, GöttingenGastrointestinal Stromal Tumours (GIST) – development in pathology, surgery and medical therapyDeveloped during the 10th German GIST-meeting, Göttingen
A. Agaimy
1   Pathologie, Universität Erlangen
,
S. Bauer
2   Innere Klinik (Tumorforschung), Universitätsklinik Essen
,
A. Beham
3   Allgemein-Viszeral- und Kinderchirurgie, Universitätsmedizin Göttingen
,
J. Bertolini
4   Institut für Pathologie, Hamburg
,
F. Haller
1   Pathologie, Universität Erlangen
,
R. Koschny
5   Medizinische Klinik IV, Universität Heidelberg
,
J. Maier
6   Hämatologie und Hämostaseologie, Universität Leipzig
,
M. Montemurro
7   Sarcoma Unit, Royal Marsden Hospital, London
,
D. Perez
8   Allgemein-Viszeral- und Thoraxchirurgie, Universität Hamburg
,
I.-M. Schaefer
9   Pathology, Brigham and Women's Hospital, Boston, MA.
,
H.-U. Schildhaus
10   Pathologie, Universitätsmedizin Göttingen
,
C. Wurst
11   Allgemein- und Viszeralchirurgie, Universitätsklinikum Jena
,
S. Cameron
12   Gastroenterologie und Endokrinologie, Universitätsmedizin Göttingen
› Author Affiliations
Further Information

Publication History

09 July 2014

10 November 2014

Publication Date:
16 March 2015 (online)

Zusammenfassung

Mit der Erstbeschreibung der Liganden-unabhängigen aktivierenden Mutationen in dem für die Tyrosinkinase KIT kodierenden Gen KIT entwickelte sich ein Verständnis für die Biologie gastrointestinaler Stromatumoren (GIST). Als „Paradigma zielgerichteter Therapie“ gab es Impulse für das Verständnis von Resistenzmechanismen und die Behandlung anderer Kinase-abhängiger Tumoren. Zum Austausch aktueller Erkenntnisse auf dem Gebiet des GIST findet seit nunmehr 10 Jahren im Dezember das deutsche GIST-Treffen traditionell in Göttingen statt. Klinische Diagnostik, Pathologie, Chirurgie und medikamentöse Therapie bilden dabei die wichtigsten Themengruppen. Die folgende Darstellung gibt eine Übersicht über die diskutierten Inhalte und Besonderheiten von GIST einschließlich aktueller Daten der verschiedenen Themengebiete.

Abstract

The first description of ligand-independent activating mutations in the KIT gene, which encodes the tyrosine-kinase KIT, greatly improved our understanding of gastrointestinal stromal tumour (GIST) biology. The therapeutic success in GIST has made tyrosine kinase inhibitors a “paradigm of targeted therapy”. Deciphering resistance mechanisms in GIST has had implications for many other kinase-driven cancers. To exchange current knowledge within the field of GIST, the German GIST Meeting has taken place for now 10 years, traditionally in Göttingen. Subjects discussed include clinical diagnostics, pathology, surgery, and medical therapy. The following presentation gives an overview of the last meeting held in December 2013, including distinctive features in GIST and current data on the different topics.

 
  • Literatur

  • 1 Hirota S, Isozaki K, Moriyama Y et al. Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 1998; 279: 577-580
  • 2 Miettinen M, Lasota J. Gastrointestinal stromal tumors: pathology and prognosis at different sites. Semin Diagn Pathol 2006; 23: 70-83
  • 3 Miettinen M, Lasota J. Gastrointestinal stromal tumors (GISTs): definition, occurrence, pathology, differential diagnosis and molecular genetics. Pol J Pathol 2003; 54: 3-24
  • 4 Gastrointestinal Stromal Tumour (GIST) Rules for Classification. In: Sobin L, Gospodarowicz M, Wittekind C, (eds.). TNM Classification of Malignant Tumours. 7. Edition. West Sussex: Wiley-Blackwell; 2010: 78-85
  • 5 Wittekind C, Asamura H, Sobin LH (Hrsg.). TNM Atlas. 6th Ed. 2014
  • 6 Miettinen M, Lasota J. Gastrointestinal stromal tumors: review on morphology, molecular pathology, prognosis, and differential diagnosis. Arch Pathol Lab Med 2006; 130: 1466-1478
  • 7 Hohenberger P, Wardelmann E. [Surgical considerations for gastrointestinal stroma tumor]. Chirurg 2006; 77: 33-40
  • 8 Agaimy A. Gastrointestinal stromal tumors (GIST) from risk stratification systems to the new TNM proposal: more questions than answers? A review emphasizing the need for a standardized GIST reporting. Int J Clin Exp Pathol 2010; 3: 461-471
  • 9 Agaimy A. Risk assessment and pathological reporting of gastrointestinal stromal tumour. Diagnostic Histopathology 2013; DOI: doi.org/10.1016/j.mpdhp.2013.03.001.
  • 10 Agaimy A, Otto C, Braun A et al. Value of epithelioid morphology and PDGFRA immunostaining pattern for prediction of PDGFRA mutated genotype in gastrointestinal stromal tumors (GISTs). Int J Clin Exp Pathol 2013; 6: 1839-1846
  • 11 Kunstlinger H, Binot E, Merkelbach-Bruse S et al. High-resolution melting analysis is a sensitive diagnostic tool to detect imatinib-resistant and imatinib-sensitive PDGFRA exon 18 mutations in gastrointestinal stromal tumors. Hum Pathol 2014; 45: 573-582
  • 12 Kunstlinger H, Huss S, Merkelbach-Bruse S et al. Gastrointestinal stromal tumors with KIT exon 9 mutations: Update on genotype-phenotype correlation and validation of a high-resolution melting assay for mutational testing. Am J Surg Pathol 2013; 37: 1648-1659
  • 13 Huss S, Kunstlinger H, Wardelmann E et al. A subset of gastrointestinal stromal tumors previously regarded as wild-type tumors carries somatic activating mutations in KIT exon 8 (p.D419del). Mod Pathol 2013; 26: 1004-1012
  • 14 Agaimy A, Terracciano LM, Dirnhofer S et al. V600E BRAF mutations are alternative early molecular events in a subset of KIT/PDGFRA wild-type gastrointestinal stromal tumours. J Clin Pathol 2009; 62: 613-616
  • 15 Andersson J, Sihto H, Meis-Kindblom JM et al. NF1-associated gastrointestinal stromal tumors have unique clinical, phenotypic, and genotypic characteristics. Am J Surg Pathol 2005; 29: 1170-1176
  • 16 Miettinen M, Lasota J. Succinate dehydrogenase deficient gastrointestinal stromal tumors (GISTs) – A review. Int J Biochem Cell Biol 2014; 53: 514-519
  • 17 Haller F, Moskalev EA, Faucz FR et al. Aberrant DNA hypermethylation of SDHC: a novel mechanism of tumor development in Carney triad. Endocr Relat Cancer 2014; 21: 567-577
  • 18 Agaimy A, Wunsch PH, Hofstaedter F et al. Minute gastric sclerosing stromal tumors (GIST tumorlets) are common in adults and frequently show c-KIT mutations. Am J Surg Pathol 2007; 31: 113-120
  • 19 Cameron S, Haller F, Dudas J et al. Immune cells in primary gastrointestinal stromal tumors. Eur J Gastroenterol Hepatol 2008; 20: 327-334
  • 20 Balachandran VP, Cavnar MJ, Zeng S et al. Imatinib potentiates antitumor T cell responses in gastrointestinal stromal tumor through the inhibition of Ido. Nat Med 2011; 17: 1094-1100
  • 21 Menard C, Blay JY, Borg C et al. Natural killer cell IFN-gamma levels predict long-term survival with imatinib mesylate therapy in gastrointestinal stromal tumor-bearing patients. Cancer Res 2009; 69: 3563-3569
  • 22 Rusakiewicz S, Semeraro M, Sarabi M et al. Immune infiltrates are prognostic factors in localized gastrointestinal stromal tumors. Cancer Res 2013; 73: 3499-3510
  • 23 van Dongen M. Savage ND, Jordanova ES, Briaire-de Bruijn IH, Walburg KV, Ottenhoff TH, Hogendoorn PC, van der Burg SH, Gelderblom H, van HT. Anti-inflammatory M2 type macrophages characterize metastasized and tyrosine kinase inhibitor-treated gastrointestinal stromal tumors. Int J Cancer 2010; 127: 899-909
  • 24 Gunawan B, von Heydebreck A, Sander B et al. An oncogenetic tree model in gastrointestinal stromal tumours (GISTs) identifies different pathways of cytogenetic evolution with prognostic implications. J Pathol 2007; 211: 463-470
  • 25 Wang Y, Marino-Enriquez A, Bennett RR et al. Dystrophin is a tumor suppressor in human cancers with myogenic programs. Nat Genet 2014; 46: 601-606
  • 26 Maier J, Lange T, Kerle I et al. Detection of mutant free circulating tumor DNA in the plasma of patients with gastrointestinal stromal tumor harboring activating mutations of CKIT or PDGFRA. Clin Cancer Res 2013; 19: 4854-4867
  • 27 Kang HC, Menias CO, Gaballah AH et al. Beyond the GIST: mesenchymal tumors of the stomach. Radiographics 2013; 33: 1673-1690
  • 28 Joensuu H, Vehtari A, Riihimaki J et al. Risk of recurrence of gastrointestinal stromal tumour after surgery: an analysis of pooled population-based cohorts. Lancet Oncol 2012; 13: 265-274
  • 29 Padhi S, Kongara R, Uppin SG et al. Extragastrointestinal stromal tumor arising in the pancreas: a case report with a review of the literature. JOP 2010; 11: 244-248
  • 30 Agaimy A, Wuensch PH. Gastrointestinal stromal tumours in patients with other-type cancer: a mere coincidence or an etiological association? A study of 97 GIST cases. Z Gastroenterol 2005; 43: 1025-1030
  • 31 McCarter MD, Antonescu CR, Ballman KV et al. Microscopically positive margins for primary gastrointestinal stromal tumors: analysis of risk factors and tumor recurrence. J Am Coll Surg 2012; 215: 53-59
  • 32 Bamboat ZM, DeMatteo RP. Metastasectomy for gastrointestinal stromal tumors. J Surg Oncol 2014; 109: 23-27
  • 33 Zaydfudim V, Okuno SH, Que FG et al. Role of operative therapy in treatment of metastatic gastrointestinal stromal tumors. J Surg Res 2012; 177: 248-254
  • 34 Bauer S, Rutkowski P, Hohenberger P et al. Long-term follow-up of patients with GIST undergoing metastasectomy in the era of imatinib – analysis of prognostic factors (EORTC-STBSG collaborative study). Eur J Surg Oncol 2014; 40: 412-419
  • 35 DeMatteo RP, Ballman KV, Antonescu CR et al. Long-term results of adjuvant imatinib mesylate in localized, high-risk, primary gastrointestinal stromal tumor: ACOSOG Z9000 (Alliance) intergroup phase 2 trial. Ann Surg 2013; 258: 422-429
  • 36 DeMatteo RP, Ballman KV, Antonescu CR et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet 2009; 373: 1097-1104
  • 37 Casali PG, LeCesne A, Velasco AP et al. Imatinib failure-free survival (IFS) in patients with localized gastrointestinal stromal tumors (GIST) treated with adjuvant imatinib (IM): The EORTC/AGITG/FSG/GEIS/ISG randomized controlled phase III trial. J Clin Oncol 2013; 31 : suppl. Abstract 1050
  • 38 Joensuu H, Eriksson M, Sundby HK et al. One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial. JAMA 2012; 307: 1265-1272
  • 39 Palesandro E, Galizia D, D'Ambrosio L et al. A risk-based individualized follow-up after complete surgery as an effective procedure to reduce the relapse (R) impact in GIST patients (pts). J Clin Oncol 2013; 31 : suppl. Abstract 10552
  • 40 Joensuu H, Eriksson M, Hall KS et al. Risk factors for gastrointestinal stromal tumor recurrence in patients treated with adjuvant imatinib. Cancer 2014; 120: 2325-2333
  • 41 Domont J, Chabaud S, Ray-Coquard I et al. Impact of mutational status and other prognostic factors on survival in patients with advanced GIST treated with standard-dose imatinib (IM): Results from the BFR14 phase III trial of the French Sarcoma Group. J Clin Oncol 2013; 31 : suppl. Abstract 10548
  • 42 Emile JF, Ray-Coquard I, Bui B et al. Relationship of the topography of KIT exon 11 alterations and predictive value for PFS in patients with advanced GIST: Results of the BFR14 prospective French Sarcoma Group randomized phase III trial. J Clin Oncol 2013; 31 : suppl. Abstract 10542
  • 43 Conley AP, Guerin A, Sasane M et al. Predictors of complete response following disease recurrence in gastrointestinal stromal tumor (GIST) patient: A retrospective patient chart review analysis. J Clin Oncol 2013; 31 : suppl. Abstract 10545
  • 44 Kang YK, Ryu MH, Ryoo BY et al. Randomized phase III trial of imatinib (IM) rechallenge versus placebo (PL) in patients (pts) with metastatic and/or unresectable gastrointestinal stromal tumor (GIST) after failure of at least both IM and sunitinib (SU): RIGHT study. J Clin Oncol 2013; 31 : suppl. Abstract LBA 20502
  • 45 Ryoo BY, Park SJ, Ryu MH et al. The role of surgical resection following imatinib treatment in patients with metastatic or recurrent GIST. J Clin Oncol 2013; 31 : suppl. Abstract 10550
  • 46 Gedaly R, Angulo P, Hundley J et al. PKI-587 and sorafenib targeting PI3K/AKT/mTOR and Ras/Raf/MAPK pathways synergistically inhibit HCC cell proliferation. J Surg Res 2012; 176: 542-548
  • 47 Kindler HL, Campbell NP, Wroblewski K et al. Sorafenib (SOR) in patients (pts) with imatinib (IM) and sunitinib (SU)-resistant (RES) gastrointestinal stromal tumors (GIST): Final results of a University of Chicago Phase II Consortium trial. J Clin Oncol 2011; 29 : suppl. Abstract 10009
  • 48 Park SH, Ryu MH, Ryoo BY et al. Sorafenib in patients with metastatic gastrointestinal stromal tumors who failed two or more prior tyrosine kinase inhibitors: a phase II study of Korean gastrointestinal stromal tumors study group. Invest New Drugs 2012; 30: 2377-2383
  • 49 Corless CL, Barnett CM, Heinrich MC. Gastrointestinal stromal tumours: origin and molecular oncology. Nat Rev Cancer 2011; 11: 865-878
  • 50 Hohenberger P, Wang M, Heydt C et al. Interrelationship of primary and secondary mutations in gastrointestinal stromal tumors during TKI therapy. J Clin Oncol 2014; 32 : suppl. Abstract 10518
  • 51 Demetri GD, Reichardt P, Kang YK et al. Efficacy and safety of regorafenib for advanced gastrointestinal stromal tumours after failure of imatinib and sunitinib (GRID): an international, multicentre, randomised, placebo-controlled, phase 3 trial. Lancet 2013; 381: 295-302
  • 52 Wilhelm SM, Dumas J, Adnane L et al. Regorafenib (BAY 73-4506): a new oral multikinase inhibitor of angiogenic, stromal and oncogenic receptor tyrosine kinases with potent preclinical antitumor activity. Int J Cancer 2011; 129: 245-255
  • 53 Heinrich MC, Fletcher JA, Anjum R et al. Use of ponatinib to inhibit kinase mutations associated with drug-resistant gastrointestinal stromal tumors (GIST). J Clin Oncol 2013; 31 : suppl. Abstract 10509
  • 54 Garner AP, Gozgit JM, Anjum R et al. Ponatinib inhibits polyclonal drug-resistant KIT oncoproteins and shows therapeutic potential in heavily pretreated gastrointestinal stromal tumor (GIST) patients. Clin Cancer Res 2014; 20: 5745-5755
  • 55 Borad MJ, Champion MD, Egan JB et al. Integrated genomic characterization reveals novel, therapeutically relevant drug targets in FGFR and EGFR pathways in sporadic intrahepatic cholangiocarcinoma. PLoS Genet 2014; 10: e1004135
  • 56 Dubreuil P, Letard S, Ciufolini M et al. Masitinib (AB1010), a potent and selective tyrosine kinase inhibitor targeting KIT. PLoS One 2009; 4: e7258
  • 57 Adenis A, Blay JY, Bui-Nguyen B et al. Masitinib in advanced gastrointestinal stromal tumor (GIST) after failure of imatinib: a randomized controlled open-label trial. Ann Oncol 2014; 25: 1762-1769
  • 58 Demetri GD, Rankin CJ, Benjamin RS et al. Long-term disease control of advanced gastrointestinal stromal tumors (GIST) with imatinib: 10-year outcomes from SWOG phase III intergroup trial S0033. J Clin Oncol 2014; 32: 5s
  • 59 Perez DR, Baser RE, Cavnar MJ et al. Blood neutrophil-to-lymphocyte ratio is prognostic in gastrointestinal stromal tumor. Ann Surg Oncol 2013; 20: 593-599
  • 60 Shoushtari AN, D'Angelo SP, Keohan ML et al. Combined KIT and CTLA-4 blockade in patients with refractory GIST and other advanced sarcomas. J Clin Oncol 2014; 32 : suppl. Abstract 10521
  • 61 Tielen R, Custers J, Prins J et al. Fear of disease progression in patients with gastrointestinal stromal tumors (GIST). J Clin Oncol 2013; 31 : suppl. Abstract 10549
  • 62 Duffaud F, Ray-Coquard I, Marchal F et al. Clinical experience with sunitinib (SU) in patients over age 65 with metastatic gastrointestinal stromal tumors (GIST): A retrospective study from the French Sarcoma Group (FSG). J Clin Oncol 2013; 31 : suppl. Abstract 10546
  • 63 Corless CL, Ballman KV, Antonescu CR et al. Pathologic and molecular features correlate with long-term outcome after adjuvant therapy of resected primary GI stromal tumor: the ACOSOG Z9001 trial. J Clin Oncol 2014; 32: 1563-1570
  • 64 Fletcher CD, Berman JJ, Corless C et al. Diagnosis of gastrointestinal stromal tumors: A consensus approach. Hum Pathol 2002; 33: 459-465
  • 65 Demetri GD, van Oosterom AT, Garrett CR et al. Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: a randomised controlled trial. Lancet 2006; 368: 1329-1338
  • 66 Heinrich MC, Maki RG, Corless CL et al. Primary and secondary kinase genotypes correlate with the biological and clinical activity of sunitinib in imatinib-resistant gastrointestinal stromal tumor. J Clin Oncol 2008; 26: 5352-5359
  • 67 Heinrich MC, Marino-Enriquez A, Presnell A et al. Sorafenib inhibits many kinase mutations associated with drug-resistant gastrointestinal stromal tumors. Mol Cancer Ther 2012; 11: 1770-1780