Clinical Observation Of Sunitinib As Second. Line Treatment For Gastrointestinal Stromal Tumor

Background Gastrointestinal stromal tumor(GIST)is the most common gastrointestinal mesenchymal tumor,accounting for 1% ~ 3% of all gastrointestinal tumors,where it comes from is that the stomach is the most common(60% ~ 60%),followed by the small intestine(20% ~ 30%),then the mesenteric,omentum and abdominal pelvic cavity rarely.And in our country’s one million people each year there are about 10 to 20 new cases in one million every year.Surgical resection is the standard treatment for resectable GIST,and after surgery about 40% ~ 80% of GIST patients will reappear in local recurrence or distant metastasis,and the 5-year survival rate is only 45%.Furthermore the 1 year survival rate of the shift is of less than 30%.Targeted drugs imatinib mesylate(gleevec)curing GIST has good effect,but in the process of treatment the rate of anti-imatinib mesylate is 63%.Sunitinib malate(sutent)is currently the only approved for imatinib resistant patients as a second-line drug,but the domestic study of such reports are few.Purpose The present study aims to examine the effect of sunitinib malate,a second-line therapy for gastrointestinal stromal tumors(GIST),on clinical response in Chinsese GIST patients,and further investigate the efficacy and toxicity profile of sunitinib malate,as well as it’s influence on survival rates.Methods We retrospectively reviewed clinical data from 32 patients with a histopathologically and immunohistochemically confirmed diagnosis of GIST who were referred to the General Surgery Department,the first affiliated hospital of anhui medical university,between Jan 2010 to May 2016.All patients were treated with sunitinib as the second line treatment 37.5 mg/day on CDD(continuous daily dosing)schedule.Toxicity of sunitinib therapy and patients’ survival time were analyzed.Results 1.The average age of 32 patients including 22 males and 10 females was 55.6 years old(median onset age 64 years old),which the rate of male to female was 2.2:1 and the patients including 40~60 were more.2.After given to Gleevec for 12~24 months,32 patients appeared the progress of the disease,furthermore,they continued in the wake of a progression after taking imatinib mesylate for 3 ~ 6 months and the progress couldn’t be controlled.3.After taking sunitinib malate,the tumor growth of some of 32 patients were stopping or diminising gradully,and the progress of the vast majority of the patient was under control or gradually reduced.4.After taking imatinib mesylate among 32 patients,a series of adverse reactions included water sodium retention,skin pigment loss,skin allergy,blood toxicity,cardiovascular toxicity,and so on;after tking sunitinib malate,in adtion to common adverse reactions,some special adverse reactions included extremitis syndrome,hypothyroidism,cardiac toxicity,and high blood pressure,etc.5.One year and 2 year survival rates of 32 cases of patients with gastrointestinal stromal tumor were 78% and 46.9% respectively.The median PFS was 55 weeks,and the median OS 96 weeks.And the longest survival time of patients survived was more than 5 years.Conclusion 1.Gastrointestinal stromal tumor is a relatively rare gastrointestinal mesenchymal tumors between 40 ~ 60 years old.And men are more than women.2.For gastrointestinal stromal tumor,targeted therapy imatinib mesylate can obviously improve or delay the progress of patients,but with the use of drugs,the patients appeared drug resistance gradually,so to continue taking imatinib mesylate results into bad effect.3.To imatinib mesylate drug resistance in patients with gastrointestinal stromal tumor,second line application sunitinib malate,the progress of the disease can be obviously controlled,especially early applied effectively for gastrointestinal stromal tumor.4.For Gastrointestinal stromal tumor,after taking sunitinib malate patients will appear different reactions,while the adverse reaction is tolerated.After taking sunitinib malate the adverse reactions include there leukopenia,liver function damage syndrome,hypothyroidism,thrombocytopenia,hands and feet,anorexia,fatigue,inflammation of the oral mucosa and skin toxicity and so on.The adverse reactions are more in level 1 ~ 2,and less in 3 ~ 4 grade,without ceasing because of adverse reaction.And the symptoms can be controlled.5.Resistant to imatinib mesylate or treatment failure of patients with gastrointestinal stromal tumor,sunitinib malate can be applied for continuing treatment to make the illness ease for some patients and even fully control,therefore,this research for the failure of a gleam of targeted drugs used second-line treatment of gastrointestinal stromal tumor drug has important reference value.