Table 1.
Clinical data and tumor characteristics at the time of downsizing TKI induction and response to treatment
| Case no. (sex/age) | Status at initial diagnosis and response to TKI | Duration of TKI | Type of surgery | Status postop | Total FU (months) | Clinical benefit of downsizing TKI | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary tumor site/size (cm) | Size after TKI | Ki67 (% before/after surgery) | Mets | KIT exon11 mutation | TKI preop (months) | Extinguished 18F-FDG-PET uptake | Postop (months) | |||||
| Downsizing imatinib | ||||||||||||
| 1 (F/75) | E/10 | 3 | 10/0 | – | No DNA post TKI | 11.0 | Yes | 6 | Eres, R0 | NED | 44 | Improved nutritional status allowed resection |
| 2 (M/72) | S/20 | 8 | –/< 1 | L | Ex11 missense | 6.5 | Yes | 29 | Sres + Lres (wedge), R0 | NED | 84 | Hemihepatectomy avoided |
| 3 (M/57) | S/15 | 10 | –/< 1 | L | Ex 11 deletion | 1.0 | Yes | 24 | Sres + Lres (wedge), R0 | NED | 85 | Hemihepatectomy avoided |
| 4 (M/63) | S/16 | 11 | –/5 | – | Ex 11 deletion | 6 | Yes | 12 | Sres, R0 | NED | 33 | Gastrectomy avoided |
| 5 (M/55) | S/11.5 | 8.5 | 8/1 | L | Ex 11 missense | 4.0 | Yes | Ongoing | Sres + SE | L mets, SD | 27 | Gastrectomy, diaphragmectomy avoided |
| 6 (F/62) | S/30 | 14 | 10/< 1 | L | Ex 11 missense | 3.0 | Yes | Ongoing | Sres + LBres + OMres + SE | L met, SD | 26 | Gastrectomy avoided |
| 7 (M/56) | S/30 | 10 | 10/< 1 | L | Ex 11 deletion | 3.0 | Yes | Ongoing | Sres + SE | L met, SD | 25 | Gastrectomy avoided |
| 8 (M/56) | SB/35 | 18 | 10/< 1 | L | Ex 11 missense | 2.5 | Yes | Ongoing | SBres, reop liver resection | L mets, PD | 96 | Rectal amputation avoided |
| 9 (M/73) | SB/15 | 8 | 5/< 1 | L | Ex 11 deletion | 3.0 | Uptake in liver met | Ongoing | SBres + Dres | L mets, SD | 50 | Whipple avoided |
| Downsizing sunitinib | ||||||||||||
| 10 (M/55) | S/21 | 14 | –/< 1 | P | WT | 9a | Reduced | Ongoing | Sres | NED | 26 |
Hemihepatectomy avoided Whipple avoided |
| Mean | 20.4 | 10.5 | 4.9 | 49 | ||||||||
D duodenum, Dres duodenal resection, E esophagus, Eres esophagus resection, Ex exon, 18 F-FDG-PET 18F-fluorodeoxyglucose positron emission tomography, FU follow-up, L liver, LB large bowel, LBres large bowel resection, Lres liver resection, Mets metastasis, NED no evidence of disease, OM omentum majus, OMres omental resection, P peritoneal, PD progressive disease, res resection, S stomach, SB small bowel, SBres small bowel resection, SD stable disease, SE splenectomy, Sres stomach resection, TKI tyrosine kinase inhibitor, PD progessive disease, WT wild type
aResistance to imatinib 3 months prior to sunitinib