References

tumors

Malignant tumours

2224-50572587-6813

Rosoncoweb

10.18027/2224-5057-2013-1-15-27

tumors-18

Research Article

ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ

ORIGINAL REPORTS

МУЛЬТИДИСЦИПЛИНАРНЫЙ ПОДХОД В ДИАГНОСТИКЕ И ЛЕЧЕНИИ ГАСТРОИНТЕСТИНАЛЬНЫХ СТРОМАЛЬНЫХ ОПУХОЛЕЙ

Multidisciplinary approach in diagnosis and treatment of gastrointestinal stromal tumors.

Копп

М. В.

Kopp

M. V.

mvkopp@mail.ru

Королева

И. А.

Koroleva

I. A.

korolevaia_samara@mail.ru

ГБУЗ «Самарский областной клинический онкологический диспансер»Russian Federation

2013

20052015

011527

2015

Копп М.В., Королева И.А.

Kopp M.V., Koroleva I.A.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.malignanttumors.org/jour/article/view/18

Гастроинтестинальные стромальные опухоли (GIST-Gastrointestinal Stromal Tumors) составляют от 0,1 % до 3 % от всех злокачественных новообразований желудочно-кишечного тракта. Иммуногистохимическое исследование является ключевым в дифференциальном диагнозе GIST и других мезенхимальных опухолей. Главным иммуногистохимическим маркером GIST является CD117 (c-Kit), который гиперэкспрессирован в 95 % случаев. При планировании лечения GIST необходим мультидисциплинарный подход с участием хирурга-онколога, морфолога, онколога-химиотерапевта и рентгенолога. Хирургический метод лечения остается основным при отсутствии признаков диссеминации процесса. На прогноз прогрессирования GIST влияет размер опухоли, митотический индекс, локализация опухоли и мутационный статус опухоли. Основной препарат для терапии диссеминированного GIST — иматиниб — является низкомолекулярным ингибитором тирозинкиназ c-Kit, PDGFR, Abl, Bcr-Abl. Иматиниб применяется в дозе 400 мг / сутки и позволяет добиться клинического улучшения (частичный ответ + стабилизация) у 90 % больных. Иматиниб в послеоперационной (адъювантной) терапии в течение года достоверно увеличил безрецидивную выживаемость пациентов до 98 %. Согласно рекомендациям ESMO 2012 года больным группы высокого риска необходимо проведение адъювантной терапии иматинибом в течение 3 лет. Неоадъювантная терапия иматинибом приводит к уменьшению опухолевой массы, повышению резектабельности и частоты выполнения органосохранных операций. При прогрессировании GIST на фоне терапии иматинибом доза последнего может быть удвоена или назначен препарат второй линии — сунитиниб (ингибитор тирозинкиназы VEGFR, PDGFR, KIT, Flt3). Сунитиниб принимают по 50 мг / сутки, независимо от приема пищи в течение 4 недель ежедневно с интервалом в 2 недели. У иматниниб-резистентных больных при терапии сунитинибом клиническое улучшение было достигнуто у 24,2 % пациентов. При рентгенологической оценке ответа GIST на терапию необходимо учитывать не только размеры, но и плотность и структуру опухоли. В настоящее время проводятся клинические исследования II фазы по изучению новых таргетных препаратов для терапии GIST.

Gastrointestinal stromal tumors (GIST) constitute from 0.1% to 3% of all malignant neoplasms of the gastrointestinal tract. Immunohistochemistry plays a key role in the differential diagnosis of GIST and other mesenchymal tumors. The main immunohistochemical marker for GIST is the CD117 (c-Kit), which hyperexpression observed in 95% tumors. When planning treatment of GIST a multidisciplinary approach involving surgeon-oncologist, pathologist, oncologist and radiologist-chemotherapist is required. Surgical treatment remains the main method of treatment in the absence of dissemination of the disease. Tumor size, mitotic index, location of tumor and mutation status of tumor affect on the prognosis of disease progression. Imatinib is a small molecule inhibitor of tyrosine kinase c-Kit, PDGFR, Abl, Bcr-Abl and the main drug in treatment of metastatic GIST. Imatinib is applied in a dose of 400 mg/day, and allows to achieve a clinical improvement (partial response + stabilization) in 90% of patients. Using of imatinib in adjuvant therapy during first year after the operation significantly increases progression-free survival up to 98%. High-risk patients need adjuvant treatment with imatinib for 3 years after the operation according to the ESMO 2012 recommendations. Neoadjuvant therapy with imatinib leads to a reduction of the tumor mass, increase resectability and frequency of performing organ-preserving operations. In case of progression of GIST during therapy with imatinib the last dose may be doubled or a second-line treatment with sunitinib (tyrosine kinase inhibitor of VEGFR, PDGFR, KIT, Flt3) can be used. Sunitinib is applied in a dose of 50 mg/day for 4 weeks daily with an interval of 2 weeks. Treatment with sunitinib allowed to achieve clinical improvement in 24.2% of imatninib-resistant patients. It is necessary to take into account not only the size but also the density and structure of the tumor when performing radiological assessment of response of the tumor to therapy. Currently, the phase II clinical studies are conducted with the aim to investigate the new targeted therapies for the treatment of GIST.

гастроинтестинальные стромальные опухолигруппы рискаиматинибсунитиниб

Gastrointestinal stromal tumorsgroups of riskimatinibsunitinib

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The authors declare that there are no conflicts of interest present.