The Knife Helps Cancer Patients Make the Cut

When cancer starts to grow after treatment, it usually means genetic changes in the cancer cells have taken place. Targeted therapies designed to go after specific mutations stop working against the new changes. Now there is “provocative evidence” of an effective way to combat this biology.

A new study showed that surgery combined with the medication Gleevec (imatinib) helped patients with gastrointestinal stromal tumors (GIST) live longer than the medicine alone.

Researchers looked at the results of the combination approach in patients whose cancer had returned (recurrent) or had spread (metastasized).

Chronic pain in your abdomen needs to be checked out.

Seong Joon Park, MD, a fellow at Asan Medical Center in Seoul, South Korea, was the study’s lead author. He presented study results at the American Society of Clinical Oncology (ASCO) 2013 Gastrointestinal Cancers Symposium.

GISTs are a relatively rare cancer, diagnosed in about 4,500 Americans every year. GISTs are part of a group of cancers called soft tissue sarcomas, which appear in the tissues that support and hold the body together. Tumors can appear anywhere along the gastrointestinal tract.

Gleevec is the standard therapy for recurrent or metastasized GIST. The vast majority of patients – 80 to 85 percent – respond well to this targeted therapy, which is also used to treat leukemia (blood cancer).

Despite this treatment, many GIST patients see their tumors return or spread. The thinking has been that surgically removing these new tumors could help – and that’s what this study was designed to test.

This study involved 134 patients with metastatic or recurrent GIST who were treated with imatinib alone or surgery plus imatinib.

Researchers found that people who had surgery plus the medication had a 5.5-fold lower risk of dying from the disease than did patients who only took the medication.

Overall survival for people who had surgery and continued taking Gleevec was 87.7 months compared to 42.8 months for patients who received only the medication.

ASCO member and clinical oncologist, Neal J. Meropol, MD, moderated a press briefing on studies being presented at the GI Symposium. “This study really provides provocative evidence that taking an aggressive approach surgically, in addition to medical treatment with imatinib, may in fact result in even longer survival of patients with GI stromal tumors,” said Dr. Meropol, who is professor of Cancer Research and Therapeutics, and Chief of the Division of Hematology and Oncology at University Hospitals Case Medical Center and Case Western Reserve University.

According to the researchers, a third of patients can have residual lesions surgically removed. Clinicians make that decision based on the tumor and the overall health of the individual patient. Patients with smaller tumors, female patients and a mutation in a specific gene (KIT) typically did better both with imatinib and the dual approach.

Before publication in a peer-reviewed journal, all research should be considered preliminary.