Table 2.

Comparison of Treatment Recommendations for Gastrointestinal Stromal Tumors According to the European Society for Medical Oncology, the National Comprehensive Cancer Network, and the Canadian Advisory Committee on Gastrointestinal Stromal Tumors Guidelines

Treatment Setting	ESMO (Casali 200913)	NCCN (NCCN 200914)	Canadian (Blackstein 200612)
Primary resectable disease
First-line treatment	Surgery	Surgery	Surgery
Adjuvant imatinib	Option for patients at high risk of relapse	Option for patients at high risk of relapse	Not recommended as standard therapy and suggest enrolling high-risk patients in a clinical trial of adjuvant imatinib
Recurrent or metastatic disease
First-line treatment	Imatinib 400 mg/d	Imatinib 400 mg/d	Imatinib 400 mg/d
Standard imatinib dose	Yes (400 mg/d)	Yes (400 mg/d)	Yes (400 mg/d)
Patients with KIT exon 9	Increase imatinib dose to 800 mg/d	Increase imatinib dose to 800 mg/d	Increase imatinib dose to 800 mg/d (also recommended for PDGFRα D842V mutations)
Imatinib dose escalation	For patients with tumor progression	For patients with tumor progression	For previous imatinib responders with progression who develop secondary resistance
Neoadjuvant imatinib therapy	Recommended for patients for whom R0 surgery is not feasible or for those patients who are candidates for less mutilating cytoreductive surgery	Recommended for patients with marginally resectable tumors or for resectable GISTs with a risk of significant morbidity	Consider when surgery could result in significant morbidity or loss of organ function; consider surgery 4 to 12 mo after maximal tumor shrinkage
Second-line treatment	Continue imatinib therapy at the same dose or at an increased dose, if tolerated, in patients with limited progressive disease; switch to sunitinib if progression on or intolerance to imatinib; also consider clinical trial of a new therapy or combination therapies	Continue imatinib therapy at the same dose or at an increased dose, if tolerated, in patients with limited progressive disease; consider sunitinib or enrollment in a clinical trial	No specific recommendations after imatinib failure; consider experimental regimen in a clinical trial

ESMO indicates European Society for Medical Oncology; NCCN, National Comprehensive Cancer Network; KIT, v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog; PDGFRα, platelet-derived growth factor receptor alpha; D842V, replacement of valine (V) for aspartic acid (D) at amino acid 842 of PDGFRα; R0, complete surgical resection; GISTs, gastrointestinal stromal tumors.