甲磺酸伊马替尼治疗复发或转移性胃肠间质瘤

目的 评价甲磺酸伊马替尼进行术前辅助治疗及治疗术后复发和(或)转移性胃肠间质瘤(GISTs)的临床疗效及不良反应。方法 经病理组织学证实的GISTs 30例,其中29例CD117阳性。行术前辅助化疗2例,术后复发或已转移并失去手术机会者28例,给予甲磺酸伊马替尼200～600mg／d口服。结果 30例患者中,3例失访,25例可评价客观疗效。部分缓解(PR)15例,占60．0％;病情稳定(SD)5例,占20．0％;疾病进展(PD)5例,占20．0％。患者获益(CR PR SD)率80．0％,获益者中位无进展生存期(TTP)超过13个月。随访1年以上者22例,1年生存率为86．4％。27例可评价不良反应,其中轻度水肿23例(85.2％),Ⅰ、Ⅱ度白细胞减少11例(40．7％),Ⅰ、Ⅱ度乏力8例(29．6％),轻度腹痛4例(14．8％),Ⅰ、Ⅱ度恶心呕吐5例(18．5％),轻度皮疹3例(11．1％),出血2例(7．4％)。结论 甲磺酸伊马替尼治疗进展期GISTs疗效肯定,不良反应较轻．患者能够耐受,可以较长时期用于转移性和(或)不能手术的GISTs治疗。

Imatinib mesylate alone for refractory advanced gastrointestinal stromal tumor

OBJECTIVE: To evaluate the efficacy and safety of imatinib mesylate in the treatment of patients as preoperative supplement, or used alone for unresectable and(or) metastatic gastrointestinal stromal tumor (GIST). METHODS: A total of 30 cases with advanced GIST were proved pathologically. Among them, CD117 was detected positive in 29 patients; 2 patients received imatinib mesylate before operation and 28 patients with unresectable and(or) metastatic GIST received oral imatinib mesylate daily at dose of 200-600 mg. Three patients were lost in follow-up and the objective effect was evaluated in 25 patients. RESULTS: Fifteen of 25 patients (60.0%) achieved partial response (PR); 5 (20.0%) had stable disease (SD) and 5 (20.0%) had progression disease (PD). Median time to progression (mTTP) was more than 13 months during which most experienced benefit. Twenty-two patients had been followed-up more then 1 year. The 1-year survival rate was 86.4%. The overall median survival has not been obtained to date. Twenty-seven patients were valuable for the toxicity assessment according to the WHO standard. The main toxicity included grade I-II edema of periorbital area and lower limb in 85.2% (23/27) patients, leukopenia was present in 40.7% (11/27) and intratumoral bleeding in 7.4% (2/27). Other toxicities included mild fatigue (29.6%), abdominal pain (14.8%), efflorescence (11.1%), nausea and vomiting (18.5%). CONCLUSION: As an inhibitor of tyrosine kinase, imatinib mesylate is generally well tolerated and has been proved to be effective and safe during prolonged treatment of patients with advanced gastrointestinal stromal tumors.